Complications of single-balloon enteroscopy: A nine-year multicenter experience of 2865 procedures

Table 1 Baseline characteristics and procedural data of the patients, n (%)

Characteristic	Patients (n = 1840)
Male	1187 (64.5)
Age (year), mean ± SD	51 ± 18
History of abdominal surgery	288 (15.7)
Total SBE procedures	2865
Complete SBE	231 (12.3)
Enteroscopic approach
Per oral route only	543 (29.5)
Per anal route only	272 (14.8)
Both routes	1025 (55.7)
Abdominal compression during SBE	428 (23.3)
Procedural time, minutes, median (IQR)
Per oral route	61 (42-80)
Per anal route	60 (45-75)
Maximal insertion depth (cm), median (IQR)
Per oral route	290 (210-340)
Per anal route	190 (100-270)

SBE: Single-balloon enteroscopy; IQR: Interquartile range.

Table 2 Enteroscopic findings in all patients (n = 1840)

Characteristic	n (%)
Positive findings	1364 (74.1)
Ulcer	332 (18.0)
Diverticulum	277 (15.1)
Vascular malformation	270 (14.7)
Stricture	220 (12.0)1
Malignant stricture	41 (2.2)
Benign stricture	179 (9.7)
Erosion	80 (4.3)
Polyp	122 (6.6)
Adenocarcinoma	83 (4.5)
GIST	56 (3.0)
Lymphoma	23 (1.3)
Crohn’s disease	26 (1.4)
Other findings	50 (2.7)
Negative findings	476 (25.9)
Diagnostic yield	1364 (74.1)
Major complication	7 (0.0)

¹175 patients had strictures concurrently with other lesions.

GIST: Gastrointestinal stromal tumor.

Table 3 Intestinal perforation associated with single-balloon enteroscopy

No.	Age/sex	Previous abdominal Sx	Indication	SBE procedure	Perforation	Management	HS (day)	Outcome	Definite diagnosis
1	73/female	None	Abdominal pain	Approach: Oral	Presentation: Perforation during SBE2	Surgery	17	Recovery	Duodenal stenosis, etiology unknown
				Sedation: General anesthesia	Site of perforation: Duodenum
				Abdominal compression: Yes
				Time: 10 minutes	Size: 5 cm × 5 cm
				Finding1: Normal
2	58/female	Caesarean section	Abdominal pain	Approach: Anal	Presentation: Perforation during SBE2	An endoscopic clip was attempted. 24 hours later, the patient developed fever and signs of peritonitis. Surgery was performed, and the clip was found to have inadequately closed the perforation	11	Recovery	Abdominal adhesion
				Time: 14 minutes	Site of perforation: Ileum
				Sedation: General anesthesia
				Abdominal compression: Yes	Size: 1 cm × 3 cm
				Finding1: Normal
3	67/female	Abdominal exploration and appendectomy	Abdominal pain	Approach: Anal	Presentation: Perforation during SBE2	Surgery	12	Recovery	Small bowel lymphoma and abdominal adhesion
				Time: 7 minutes
				Sedation: General anesthesia
				Abdominal compression: Yes	Site of perforation: Ileum
				Finding1: Normal	Size: 1 cm × 2 cm
4	20/male	Abdominal exploration and appendectomy	Abdominal pain	Approach: Anal	Presentation: Perforation during SBE2	An endoscopic clip was placed immediately after perforation. During postoperative observation, the patient had persistent abdominal pain, and imaging revealed intraperitoneal free air. Surgery was performed 24 hours later	19	Recovery	Abdominal adhesion
				Time: 30 minutes	Site of perforation: Ileum
				Sedation: General anesthesia	Size: 1 cm × 1 cm
				Abdominal compression: Yes
				Finding1: Normal
5	53/male	Abdominal exploration and appendectomy	Abdominal pain	Approach: Anal	Presentation: Perforation during SBE2	An endoscopic clip was applied at the perforation site, but closure was unsuccessful. The patient developed severe abdominal pain and subsequently underwent surgery 24 hours later	14	Recovery	Abdominal adhesion
				Time: 17 minutes	Site of perforation: Ileum
				Sedation: General anesthesia	Size: 1 cm × 1 cm
				Abdominal compression: Yes
				Finding1: Normal
6	55/male	Abdominal exploration and appendectomy	Abdominal pain	Approach: Anal	Presentation: Perforation during SBE2	Surgery	13	Recovery	Small bowel lymphoma and abdominal adhesion
				Time: 28 minutes	Site of perforation: Ileum
				Sedation: General anesthesia	Size: 3 cm × 3 cm
				Abdominal compression: Yes
				Finding1: Normal
7	24/male	Partial small-bowel resection	OGIB	Approach: Anal	Presentation: Perforation during SBE2	An endoscopic clip was applied after perforation during SBE. 24 hours later, the patient developed generalized abdominal pain and high-grade fever. Surgery was performed, and intraoperative findings confirmed perforation; the clip had failed to close it	24	Recovery	Abdominal adhesion
				Time: 34 minutes	Site of perforation: Ileum
				Sedation: General anesthesia	Size: 0.5 cm × 1.5 cm
				Abdominal compression: Yes
				Finding1: Normal

¹Enteroscopic finding during the single-balloon enteroscopy procedure.

²Perforation was diagnosed immediately during single-balloon enteroscopy by visualization of intraperitoneal organ.

SBE: Single-balloon enteroscopy; OGIB: Obscure gastrointestinal bleeding; HS: Hospital stay; Sx: Surgery.