Systematic review: Safety of balloon assisted enteroscopy in Crohn’s disease

Table 1 Study demographics n (%)

	BAE studies, n = 73	DBE, n = 60	SBE, n = 11
	Patients, n = 1812	n = 1509	n = 187
Published manuscripts	47 (64)	39 (65)	8 (72)
United States center	11 (15)	9 (15)	0 (0)
Prospective	19 (26)	14 (23)	6 (55)
Published pre-2010	18 (25)	17 (28)	1 (10)
Crohn’s patients per study
5-10	26 (36)	23 (38)	3 (27)
11-25	25 (34)	20 (33)	5 (45)
> 25	22 (30)	17 (28)	3 (27)
Age, mean ± SD	42.9 ± 15.4	42.4 ± 15.5	45.0 ± 15.8

Three studies and 116 patients were solely reported as “balloon assisted enteroscopy”; 1 study included both DBE and SBE. DBE: Double balloon enteroscopy; SBE: Single balloon enteroscopy; BAE: Balloon assisted enteroscopy.

Table 2 Studies involved international institutions on their experience with balloon assisted enteroscopy

Study	Published manuscript	2010-present	United States	Prospective	Mean age	Patients	Procedures	Therapeutic	Perforations
Akarsu et al[90]	X	X			47.8	39	39	0	0
Aktas et al[95]		X	X		53	58	58	0	0
Aktas et al[92]	X	X		X	51	31	31	2	0
Arihiro et al[96]		X			56.3	32	32	9	1
Bartel et al[41]		X	X		52.6	38	38	0	0
Bartel et al[49]		X	X		54.3	7	7	7	1
Bartel et al[50]		X	X		62.7	15	15	0	0
Chen et al[84]	X	X			51	8	8	0	0
Choi et al[82]	X	X			43.5	7	7	0	0
de Ridder et al[97]	X	X		X	15	14	14	0	0
Despott et al[33]	X			X	46.4	11	13	13	1
Di Caro et al[51]	X				52	7	7	0	0
Di Nardo et al[98]	X	X		X	13	26	26	5	0
Ding et al[85]		X			39	12	22	22	1
Domagk et al[52]	X	X		X	52	11	11	0	0
Dutta et al[99]	X	X			42	14	14	0	0
Fan et al[28]	X	X		X	Not reported	77	308	0	0
Gill et al[34]	X	X			52.7	20	20	10	2
Halloran et al[35]		X	X		44.8	21	40	40	1
Hirai et al[91]	X	X			36	65	110	110	1
Huang et al[53]	X				10	7	7	0	0
Jang et al[42]	X	X			32.7	24	32	0	0
Jeon et al[54]		X			36.4	30	39	0	0
Lakatos et al[55]	X				51.6	6	6	0	0
Li et al[43]	X				49	13	13	0	0
Liu et al[56]	X				8.5	5	5	0	0
Lurix et al[57]		X	X		59	5	5	0	0
Maaser et al[58]	X	X		X	54.9	59	59	0	0
Mann et al[59]		X	X		59	9	9	0	0
Mann et al[60]		X	X		59	23	23	0	0
Manner et al[61]				X	56	20	20	0	0
Manno et al[100]	X	X		X	61	11	11	1	0
May et al[44]	X	X		X	53	9	9	0	0
Mensink et al[36]	X	X		X	53	50	50	0	0
Milewski et al[62]	X			X	45	75	75	12	0
Moreels et al[63]		X			Not reported	6	6	0	0
Morise et al[89]					13	76	76	0	0
Morishima et al[37]	X	X			36	17	35	35	0
Moschler et al[64]					35.4	193	193	0	0
Nakano et al[47]	X	X		X	64	36	36	36	0
Navaneethan et al[94]	X	X			56.8	49	59	9	1
Ohmiya et al[38]	X	X	X		41	23	23	23	0
Parker et al[65]	X				48	11	11	0	0
Pata et al[66]		X			Not reported	16	16	4	0
Peng et al[67]	X	X		X	53	15	15	0	0
Pohl et al[39]	X				Language1	19	21	21	0
Qing et al[68]	X				36	7	7	0	0
Rahman et al[48]		X			Not reported	55	55	3	1
Roushan et al[83]	X	X	X		Not reported	7	7	0	0
Russo et al[101]	X	X			47.2	6	6	0	0
Safatle et al[93]		X			57	9	9	0	0
Schulz et al[69]		X			48.6	11	11	0	0
Seiderer et al[70]	X	X			50.8	10	10	0	0
Shen et al[71]	X			X	33.9	8	8	0	0
Shi et al[72]	X	X			13	35	35	0	0
Sidhu et al[73]	X	X			61.2	39	39	0	0
Sun et al[74]		X			52	7	7	0	0
Takenaka et al[45]	X			X	52	10	10	0	0
Tsujikawa et al[102]	X	X		X	31	17	17	7	0
Uchida et al[75]	X				48.9	6	9	1	0
Urs et al[76]	X	X			12.9	5	5	0	0
Urs et al[77]		X			12.7	7	13	0	0
Watanabe et al[88]	X	X			10.5	10	20	0	0
Watanabe et al[78]		X			Not reported	59	60	0	0
Westerhoff[79]		X			Not reported	18	18	0	0
Wiarda et al[46]			X		Not reported	18	18	0	0
Xu et al[87]	X	X		X	36	21	21	0	0
Yamada et al[40]	X	X			Not reported	46	128	27	0
Yoshida et al[103]		X			37	10	10	5	0
Yu et al[86]		X		X	Not reported	36	108	0	0
Zhang et al[80]	X	X		X	31.6	5	5	0	0
Zhi et al[81]	X	X			Language1	7	7	0	0
Zhu et al[104]	X				36.3	23	23	0	0

¹Language: Unable to translate full manuscript, data was extracted from abstract which did not disclose age.

Table 3 Diagnostic and therapeutic procedures n (%)

	Procedures, n = 2340	Perforations, n = 10	Rate (%)
Diagnostic BAE	1938 (83)	3 (30)	0.15
Therapeutic BAE	402 (17)	7 (70)	1.70
Diagnostic DBE	1666 (71)	2 (20)	0.12

BAE: Balloon assisted enteroscopy; DBE: Double balloon enteroscopy.

Table 4 Balloon assisted enteroscopy cases with procedure related perforation

Study	Demographics	Site and characteristics of perforation	Therapy	Procedure	Outcome after perforation
Despott et al[33]	Long standing CD (> 30 yr) with 5 prior SB resections currently on azathioprine and steroids	3 jejunal strictures (2 inflammatory, 1 fibrotic) with severe ulcerations at stricture sites	Dilated to maximum of 16.5 mm	DBE - Technically difficult due to adhesion-related angulations and fixation, and strictures were significantly ulcerated	Perforation diagnosed within 8 h, patient had laparotomy and temporary jejunostomy. Patient made full recovery and jejunostomy was reversed.
Gill et al[34]	Retained video capsule in patient with known CD	Non-obstructing jejunal stricture with mild inflammation and ulceration at the stricture site	Dilated to 15 mm	DBE - otherwise not specified	Underwent surgery, outcome otherwise not specified.
Gill et al[34]	Known CD patient had previously responded well to dilation up to 15 mm	Distal obstructing ileal stricture with mild inflammation and ulceration at the stricture site	Dilated to 15 mm	DBE - otherwise not specified	Underwent surgery, outcome otherwise not specified.
Halloran et al[35]	Known CD patient who had undergone prior surgical resection.	Scarred bowel loop adhesion site	Not specified	DBE - Perforation occurred with overtube advancement and straightening of a scarred bowel loop	Outcome not specified.
Ding et al[85]	Known CD patient	SB stricture, otherwise not specified	Dilation related perforation, otherwise not specified	DBE - Dilation related perforation, otherwise not specified	Perforation diagnosed within 12 h, patient had laparotomy and resection with ileostomy.
Bartel et al[49]	Retained video capsule in patient with known CD	SB stricture, otherwise not specified	Not specified	DBE - Otherwise not specified	Emergent surgical intervention, otherwise outcome not specified.
Rahman et al[48]	Known CD patient	Ulcer at anastomosis site	Not specified	DBE - Perforation directly related to ulcer at anastomosis	Patient made full recovery after surgical resection and primary reanastomosis.
Navaneethan et al[94]	Known CD patient	Not specified	Not specified	Not specified	Underwent surgery, outcome otherwise not specified
Arihiro et al[96]	Known CD patient	SB stricture, otherwise not specified	Dilation related perforation, otherwise not specified	SBE - Dilation related perforation, otherwise not specified	Patient improved over time without any surgical intervention.
Hirai et al[91]	Known CD patient	SB stricture, otherwise not specified	Dilation related perforation, otherwise not specified	DBE - Dilation related perforation, otherwise not specified	Patient had emergency partial ileal resection and made a full recovery.

CD: Crohn’s disease; SB: Small bowel; DBE: Double balloon enteroscopy; SBE: Single balloon enteroscopy.