Retrospective Cohort Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Aug 16, 2025; 17(8): 107867
Published online Aug 16, 2025. doi: 10.4253/wjge.v17.i8.107867
Single balloon enteroscopy in the elderly
Marc J Zuckerman, Majd Michael, Mohammad Bashashati, Alok K Dwivedi, Nancy A Casner, Mohamed O Othman, Sherif E Elhanafi
Marc J Zuckerman, Majd Michael, Nancy A Casner, Sherif E Elhanafi, Division of Gastroenterology, Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, United States
Mohammad Bashashati, Division of Gastroenterology, Department of Internal Medicine, UT Austin, Austin, TX 78712, United States
Alok K Dwivedi, Department of Biomedical Sciences, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, United States
Mohamed O Othman, Division of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, United States
Author contributions: Zuckerman MJ contributed to concept and design and was the study supervisor and guarantor; Zuckerman MJ, Michael M, Bashashati M, Dwivedi AK, Casner NA, and Elhanafi SE contributed to acquisition of data, analysis and interpretation of data; Zuckerman MJ, Michael M, Bashashati M, Casner NA, Elhanafi SE, and Othman MO were involved in critical revision of the manuscript for important intellectual content; and all authors reviewed and approved the final submitted manuscript.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Texas Tech University Health Sciences Center El Paso, approval No. E14078.
Informed consent statement: Written informed consent was obtained from the patients before enteroscopy.
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: Technical appendix, statistical code, and dataset available from the corresponding author at marc.zuckerman@ttuhsc.edu upon reasonable request, if approved by TTUHSC El Paso IRB.
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: Marc J Zuckerman, MD, Professor, Division of Gastroenterology, Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, 4800 Alberta Drive, El Paso, TX 79905, United States. marc.zuckerman@ttuhsc.edu
Received: March 30, 2025
Revised: May 9, 2025
Accepted: June 26, 2025
Published online: August 16, 2025
Processing time: 138 Days and 13.2 Hours
Abstract
BACKGROUND

Single-balloon enteroscopy (SBE) is a minimally invasive procedure to assess and treat small bowel pathologies. The most common use is to detect suspected small bowel bleeding: Insignificant gastrointestinal (GI) bleeding or iron deficiency anaemia (IDA). The safety and feasibility of SBE in the elderly has not been adequately studied.

AIM

To assess the safety and feasibility of both antegrade and retrograde SBE in elderly patients.

METHODS

We performed a retrospective cohort study of all antegrade and retrograde SBE done at our center from March 2011 through May 2020. We collected patient’s data including demographics, indications, findings, therapeutic interventions, and complications. The cohort was divided into 3 groups: Patients younger than 65 years (group 1), patients 65-75 years (group 2), and patients older than 75 years (group 3). We used 1-way one way analysis of variance, a χ2 test, and logistic regression to compare study outcomes. The primary aim was to assess diagnostic yield, therapeutic yield and rates of complications from SBE among study groups.

RESULTS

A total of 284 SBE were performed in 227 patients. In the 227 patients, we analyzed 194 antegrade (19 in gastric bypass patients) and 33 retrograde procedures. Mean age was 62.0 (SD: 16.7), 130 patients were women (57.3%), 98 were Hispanic (43.4%), and mean body mass index was 28 (SD: 6.3). The number of patients in each group were: Group 1 (117, 51.3%), group 2 (57, 25.0%) and group 3 (53, 23.7%). Gender, ethnicity, body mass index and proportions of antegrade and retrograde were comparable between age groups. The most common indications for procedure were: Obscure GI bleeding (48%), IDA (48%), abdominal pain (14%), and others (abnormal capsule, 43%; abnormal imaging, 9.7%; diarrhea 5.3%). The elderly (group 3) were more likely to have GI bleed as the indication (42.7%, 40.4%, 67.9%, P = 0.004) without difference in IDA (44.4%, 56.1%, 47.2%, P = 0.35). Diagnostic yield was significantly higher in the elderly group (48.2%, 53.7%, 68.0%), particularly in antegrade (48.5%, 53.3%, 72.1%, P = 0.033). Angioectasias were the most common finding (21.0%) and present more often in the elderly (10.9%, 20.4%, 44%) (P < 0.001). Therapeutic interventions were also more in the elderly group (35.0%, 33.3%, 58.5%, P = 0.007). There were only 2 (0.9%) complications, including minor oropharyngeal hemorrhage and esophageal trauma and no deaths, with no difference among groups.

CONCLUSION

In a retrospective analysis of SBE, we found this procedure safe and feasible in the elderly. SBE has higher diagnostic and therapeutic yields in the elderly vs the other age groups, mainly because of the increased small bowel angioectasias.

Keywords: Enteroscopy; Elderly; Small bowel; Gastrointestinal bleed; Iron deficiency anemia

Core Tip: Single-balloon enteroscopy (SBE) is a minimally invasive procedure to evaluate and treat small bowel pathology. The safety and feasibility of SBE for elderly patients are not well established. This study found that SBE has higher diagnostic and therapeutic yields in the elderly than in the other age groups, mainly due to the increased finding of small bowel angioectasias.