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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Complications of single-balloon enteroscopy: A nine-year multicenter experience of 2865 procedures
Saif Ullah, Yang-Qiu Bai, Nicha Wareesawetsuwan, Ling-Ling Cui, Yong-Ji Danzhu, Ke Wang, Shan-Shan Zhu, Xiliya He, Xin-Guang Cao, Chang-Qing Guo, Fang-Bin Zhang
Saif Ullah, Ke Wang, Shan-Shan Zhu, Xiliya He, Xin-Guang Cao, Chang-Qing Guo, Fang-Bin Zhang, Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
Yang-Qiu Bai, Department of Gastroenterology, Henan Provincial People’s Hospital, Zhengzhou 450003, Henan Province, China
Nicha Wareesawetsuwan, Department of Medicine Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02108, United States
Ling-Ling Cui, School of Public Health, Zhengzhou University, Zhengzhou 450000, Henan Province, China
Yong-Ji Danzhu, Department of Gastroenterology, Qinghai Provincial People’s Hospital, Xining 810000, Qinghai Province, China
Author contributions: Ullah S, Bai YQ, and Zhang FB carried out the study design; Ullah S, Bai YQ, Danzhu YJ, Wang K, Zhu SS, He X, Cao XG, and Guo CQ carried out the data collection; Cui LL conducted a data analysis; Ullah S, Bai YQ, Wareesawetsuwan N, and Zhu SS explained the materials; Ullah S, Bai YQ, and Wareesawetsuwan N drafted the manuscript; Zhang FB provided learning guidance; and all authors provided critical review of the manuscript.
Institutional review board statement: This study was approved by the Medical Ethics Committee of the First Affiliated Hospital of Zhengzhou University, approval No. 2022-KY-11 36-002.
Informed consent statement: Written informed consent was obtained from all patients before the procedure.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Fang-Bin Zhang, MD, PhD, Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou 450000, Henan Province, China.
fcczhangfb@zzu.edu.cn
Received: June 11, 2025
Revised: July 19, 2025
Accepted: August 7, 2025
Published online: September 14, 2025
Processing time: 87 Days and 0.1 Hours
BACKGROUND
Single-balloon enteroscopy (SBE) is an established procedure for evaluating small bowel lesions. While its efficacy is well recognized, the incidence of major complications and their associated risk factors in a large population remain unclear.
AIM
To investigate the complications and risk factors associated with diagnostic SBE.
METHODS
This multicenter retrospective study included consecutive patients who underwent diagnostic SBE at three tertiary care hospitals between January 2016 and September 2024. Data on baseline characteristics, procedural parameters, indications, findings, and major complications were collected and analyzed.
RESULTS
A total of 2865 SBE procedures were performed in 1840 patients. The mean age was 51 ± 18 years, and 64.5% were male. The most common indication was obscure gastrointestinal bleeding (57.1%), followed by abdominal pain (30.5%). The major complication rate was 0.4% (7/1840), all of which involved acute intestinal perforation identified during the procedure. Among the perforation cases, 6 occurred in patients undergoing SBE for abdominal pain and 1 for obscure gastrointestinal bleeding. The perforation sites included the ileum (6/7) and duodenum (1/7). All cases were successfully managed surgically. Previous abdominal surgery and the use of abdominal compression were significantly associated with an increased risk of perforation (P value < 0.001 for both). In subgroup analysis, perforation rates were 2.1% (6/288) in patients with prior abdominal surgery and 1.6% (7/428) with abdominal compression.
CONCLUSION
Acute intestinal perforation is a rare but serious complication. Prior abdominal surgery and abdominal compression are important risk factors, and careful patient selection is recommended to minimize complications.
Core Tip: This large multicenter study evaluates the safety of diagnostic single-balloon enteroscopy in 2865 procedures, the largest cohort to date. While the overall major complication rate was low (0.4%), all complications were acute small bowel perforations, primarily in the ileum. Importantly, prior abdominal surgery and the use of abdominal compression significantly increased the risk of perforation. These findings reaffirm the safety profile of single-balloon enteroscopy but highlight the need for careful patient selection and technical vigilance. The study fills a critical gap by identifying key risk factors for complications in a large real-world population.
