Zuckerman MJ, Michael M, Bashashati M, Dwivedi AK, Casner NA, Othman MO, Elhanafi SE. Single balloon enteroscopy in the elderly. World J Gastrointest Endosc 2025; 17(8): 107867 [DOI: 10.4253/wjge.v17.i8.107867]
Corresponding Author of This Article
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
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
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 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.
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.
Citation: Zuckerman MJ, Michael M, Bashashati M, Dwivedi AK, Casner NA, Othman MO, Elhanafi SE. Single balloon enteroscopy in the elderly. World J Gastrointest Endosc 2025; 17(8): 107867
Single-balloon enteroscopy (SBE) is a minimally invasive procedure to assess and treat small bowel pathologies. Capsule endoscopy was introduced in 2000 as the first-line diagnostic approach to visualization of the small bowel, followed by the introduction of double-balloon enteroscopy (DBE) in 2001, then SBE as a simpler approach in 2007[1] Device-assisted enteroscopy (DAE) or deep enteroscopy currently can be done with a single-balloon system, a double-balloon system, spiral enteroscopy, or a through-the-scope balloon system[2-8]. With the ability to obtain biopsies, mark lesions, and perform therapeutic interventions, deep enteroscopy can be used both to diagnose and treat small bowel disease.
The most common usage of deep enteroscopy is to explore small intestinal bleeding: Obscure gastrointestinal (GI) bleeding and/or iron deficiency anemia (IDA). Deep enteroscopy is indicated when a small bowel lesion is suspected and investigation or treatment is required[9,10]. It is usually not performed as the initial diagnostic test. The most common indication is small bowel bleeding, but other indications include small bowel masses, polyps, malabsorption syndromes, inflammatory bowel disease, foreign-body removal, stricture dilation, access to altered anatomy for endoscopic retrograde cholangioscopy, and placement of percutaneous endoscopic jejunostomy[9]. SBE has a diagnostic yield of 58%-74% in patients with suspected small bowel disorders, with a diagnostic yield and therapeutic yield similar to DBE[4,10-13]. In a meta-analysis of four prospectively randomized controlled trials, although DBE was superior to SBE for complete small bowel visualization, diagnostic yield and ability to provide treatment were similar[14].
There is a concern regarding performance of endoscopic procedures in the elderly given the increased frequency of comorbidities[15]. Many procedures have been shown to be safe in the elderly, with some caveats regarding indications and anesthesia, including upper endoscopy, colonoscopy, and cholangioscopy[16-19]. DAE is a complex procedure that may take a long time. Complications may occur, including those related to sedation, bleeding, pancreatitis, post-procedure abdominal pain, and bowel perforation[20]. There have been few studies of DAE in the elderly and most have been series with DBE[21-23]. The feasibility and safety of SBE in the elderly are not established. Here, we evaluated the safety and feasibility of both antegrade and retrograde SBE in elderly patients in a cohort study dividing patients into three groups: Very elderly, elderly, and younger patients.
MATERIALS AND METHODS
Study design
This was a retrospective cohort study of all antegrade and retrograde SBE done at a single center, University Medical Center of El Paso, a general and tertiary hospital along the United States-Mexico border, from March 2011 through May 2020. Patients younger than 18 years old were excluded. Only the first enteroscopy procedure was included in the analysis if the patient had more than one procedure. We collected patient data including demographics, clinical characteristics, endoscopy procedure data. The cohort was divided into 3 groups: Patients younger than 65 (group 1), patients 65-75 years (group 2), and patients older than 75 years (group 3). For outpatients, a post-procedure nurse made a telephone call to the patient the day after the procedure to assess for complications. The study was approved by the Texas Tech University Health Sciences Center Institutional Review Board and was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki.
Procedures
All procedures were performed with the Olympus SIF-Q180 single-balloon enteroscope (Olympus, Melville, NY, United States), the balloon overtube system, and the inflation/deflation device. Only SBE, and not DBE, are available at our institution. The treatment of small bowel angioectasias was done with Argon Plasma Coagulation (Erbe, Marietta, GA, United States). During the time of the study, an external cap was not used on the tip of the enteroscope. Procedures were done with general anesthesia or monitored anesthesia care with the supervision of an anesthesiologist. All enteroscopy procedures were performed by a single experienced endoscopist (Zuckerman MJ). Preparation for the procedure was nothing by mouth after midnight for antegrade enterosocpy and clear liquids followed by polyethylene glycol prep for retrograde enteroscopy. The area near the point of maximal insertion was usually tattooed with 0.5 mL carbon black. Depth of insertion was estimated on withdrawal by counting 10 cm intervals as the endoscope was slowly withdrawn, similar to the technique described by Efthymiou et al[24] and utilized by Christian et al[25] for retrograde enteroscopy. Technical success was defined as the insertion of the endoscope past the ligament of Treitz for antegrade procedures and greater than 20 cm beyond the ileocecal valve for retrograde procedures[25]. All patients were monitored for complications including uncontrolled bleeding (defined as the need for blood transfusion), GI perforation, infection, pancreatitis, abdominal pain, fever, nausea, and vomiting, throughout the procedure and for 24 hours afterwards.
Generally, capsule endoscopy prior to enteroscopy was performed as first-line procedure to increase diagnostic yield and to determine the best route of approach (antegrade or retrograde). Patients with significant findings (including ulcers, erosions, angioectasias, polyps, masses, and blood in the lumen) on capsule endoscopy proceeded with enteroscopy. In cases where cross-sectional imaging suggested possible pathology or there were concerns about intestinal obstruction or adhesions, capsule endoscopy was deferred prior to performing SBE, in accordance with the American College of Gastroenterology guideline[26]. Our strategy with overt small intestinal bleeding was to proceed directly to SBE without doing a capsule endoscopy[26].
Endpoints
The primary aim was to assess diagnostic yield defined as the proportion of diagnostic tests or procedures that result in a definitive primary diagnosis, depth of insertion, intervention, therapeutic yield, and rates of complications from SBE in the elderly compared with younger patients. Significant findings were considered to be ulcers/erosions, angioectasias, polyps, masses, strictures, inflammation, diverticulum, submucosal lesions, varices, and blood. We recorded our outcome data based on significant primary findings, regardless of the number of significant findings. Therefore, patients with multiple lesions were counted as having a significant lesion present. Interventions included any therapeutics performed whereas therapeutic yield was only applicable to patients excluding tissue sampling or polypectomy. The enteroscopy procedure data (depth of insertion for successful endoscopy cases, diagnostic yield, findings, and interventions) were reviewed to obtain the primary endpoints.
Covariates
The electronic medical record was used to obtain information about patient demographics including age, sex, ethnicity, and clinical characteristics including body mass index (BMI, kg/m2). In addition, the indication of enteroscopy, number of indications, use of prior video capsule endoscopy, and routes (antegrade, retrograde) were also collected. The indications for enteroscopy included overt GI bleeding, IDA, abdominal pain, chronic diarrhea, abnormal capsule endoscopy finding, and abnormal imaging.
Statistical analysis
We summarized all the continuous data (age, BMI, and depth of insertion) with mean and SD while categorical data with frequency and percentage for the entire cohort and by the age groups. The depth of insertion (cm) was analyzed on the logarithmic transformed scale. The continuous data were compared among three age groups using a one-way analysis of variance followed by a post-hoc group comparison using Bonferroni’s correction. All categorical data were compared between groups using a χ2 test. In the adjusted analysis, diagnostic yield (abnormal vs normal) and intervention (performed vs not performed) were analyzed using a logistic regression analysis after adjusting for baseline covariates. However, the diagnostic findings (normal, angioectasias, erosion/ulcer, and others) were analyzed with multinomial logistic regression analysis. A multivariable linear regression analysis was used to analyze the depth of the scope in adjusted analysis. These analyses were further conducted separately for the route of enteroscopy including antegrade and retrograde and validated by excluding bypass cases from the antegrade route. The results of logistic regression were summarized with odds ratio (OR) with a 95% confidence interval (CI) while the results of multinomial logistic regression were summarized with relative risk ratio/OR with a 95%CI. The linear regression findings were summarized with adjusted mean differences (regression coefficients) with a 95%CI. The overall multivariable analyses were adjusted for gender, ethnicity, BMI, route, and indication of the procedures. Findings with p-values less than 0.05 were considered statistically significant results. Statistical analyses were conducted using STATA 17 and as per the statistical analysis and methods in biomedical research checklist[27,28].
RESULTS
Patient characteristics
A total of 284 SBEs (228 antegrade and 56 retrograde) were performed in 227 patients. In these 227 patients, 194 (85.5%) antegrade (19 in gastric bypass patients) and 33 (14.5%) retrograde procedures were analyzed. The average (SD) age of patients was 62 (16.7) years with an average BMI of 28 (6.3) kg/m2. The majority of the patients were women (n = 130, 57.3%) and 98 were Hispanics (43.4%) (Table 1). The number of patients in each group was: Group 1 (117, 51.3%), group 2 (57, 25.0%) and group 3 (53, 23.7%). Gender, ethnicity, BMI, and proportions of antegrade and retrograde were similar between age groups (Table 1).
Table 1 Demographics and clinical characteristics of patients in the entire cohort and by age groups, n (%).
The most common indications for SBE were obscure GI bleeding (48%), IDA (48%), abdominal pain (13%), and others (abnormal capsule, 43%; abnormal imaging, 9.7%; diarrhea 5.3%). The elderly (group3) were more likely to have GI bleed as the indication (42.7%, 40.4%, 67.9%, P = 0.004) without a difference in IDA (44.4%, 56.1%, 47.2%, P = 0.35). In contrast, abdominal pain indication (23.9%, 3.5%, 3.8%) was significantly higher in group 1 (elderly age < 65 years) patients. In addition, abnormal imaging (16.2%, 5.3%, 3.7%) was more frequent indication in group 1 compared with group 2 or group 3 patients. No differences in diarrhea or abnormal capsule were noticed among groups. A video capsule endoscopy had been done prior to SBE in 160 (70.8%) of patients, with no significant difference between groups (P = 0.39) (Table 1). Among those who underwent capsule endoscopy (n = 160), 81 had positive findings with a diagnostic yield of 50.6%, with a similar trend in diagnostic yield, intervention, and therapeutic yield across ages as noted in the entire cohort.
SBE findings and interventions
There was a trend for diagnostic yield to be higher in the elderly group (48.2%, 53.7%, 68%, P = 0.066) with a significant difference between group 1 and group 3 (P = 0.020). Angioectasias were the most common finding (21.0%) followed by erosion/ulcer (10.8%) (Table 2). The other diagnoses included polyps (n = 8), gastritis (n = 6), strictures (n = 5), mass (n = 5), abnormal mucosa (n = 5), submucosal lesion (n = 4), diverticulum (n = 3), varices (n = 2), inflammation (n = 1), lymphangiectasias (n = 1), blood in lumen (n = 1), and telangiectasia (n = 1), and miscellaneous (n = 9) (Table 2).
Table 2 Differences in the outcomes between age groups among single-balloon enteroscopy patients.
Angioectasias was present more often in the elderly group (10.9%, 20.4%, 44.0%) (P < 0.001) (Table 2). Therapeutic interventions were performed on 91 patients (40.1%). The most common intervention was Aragon plasma coagulation (48, 52.8%) followed by tissue sampling (31, 34.1%), polypectomy (4, 4.4%), and hemoclip (3, 3.3%), 1 case each for epinephrine injection and hemospray, foreign body removal, sent for surgery and kangaroo tube was placed. The elderly patients in group 3 received significantly more therapeutic interventions compared with younger groups (35%, 33.3%, 57.4%, P = 0.007). Of these therapeutic interventions, 35 patients went for tissue sampling or polypectomy, while 56 received other interventions. The therapeutic yield was significantly higher in group 3 compared with group 1 and group 2 patients (14.5%, 21.1%, 50.9%, P < 0.001). There were only 2 (0.9%) minor complications including minor oropharyngeal hemorrhage and esophageal trauma and no major complications or deaths, with no difference among groups (Table 2).
After adjusting for BMI, gender, ethnicity, route of enteroscopy, and indication, significant differences among the age groups were observed (Table 3). Diagnostic yield (OR = 2.38; 95%CI: 1.14-4.96) (P = 0.021) remained significantly higher in the very elderly group (group 3) compared with group 1. In the diagnostic findings, angioectasia (OR = 7.16; 95%CI: 2.79-18.38, P < 0.001) was associated with group 3 compared with group 1. Interventions were also more frequent in the very elderly (group 3) with an OR of 3.15 (95%CI: 1.54-6.47, P = 0.002) in the adjusted analysis (Table 3). Results were unchanged after excluding the gastric bypass patients (Supplementary Table 1).
Table 3 Adjusted differences in the outcomes by age groups.
Differences in the outcomes between age groups among antegrade SBE patients: The diagnostic yield was 55.1% and was greatest in the very elderly group (48.5%, 53.3%, 72.1%) (P = 0.033). The most common finding was angioectasias in 23.5%, more frequent in the very elderly group (12.1%, 24.4%, 48.8%, P < 0.001) in the unadjusted analysis. Interventions were done in 42.8% patients and were more frequent in the very old group (37.5%, 37.8%, 60.0%, P = 0.029) in the unadjusted analyses. Therapeutic yield was significantly higher in elderly group (group 3) compared to group 1 and group 2 (16.4%, 24.4%, 51.1%, P < 0.001). The mean estimated depth of insertion was 227.1 (SD: 59.1) cm distal to the pylorus with no significant difference between age groups (227, 212, 242 cm), but a trend toward greater distance in the very elderly group (P = 0.060). These results were unchanged even after excluding gastric bypass cases from the analysis (Table 4 and Supplementary Table 2).
Table 4 Differences in the outcomes between age groups among single-balloon enteroscopy patients by type of single-balloon enteroscopy.
After adjusting for BMI, gender, ethnicity, and indication, the diagnostic yield (OR = 3.02; 95%CI: 1.32-6.93, P = 0.009), angioectasia finding (OR = 7.7; 95%CI: 2.81-21.14, P < 0.001), and interventions (OR = 2.69; 95%CI: 1.23-5.9, P = 0.013) were significantly associated with the very elderly group after excluding bypass cases (Table 5).
Table 5 Adjusted differences in the outcomes by age groups by type of single-balloon enteroscopy after removing gastric bypass.
Factor
< 65 years
65-75 years
> 75 years
Reference
OR (95%CI)
P value
OR (95%CI)
P value
Diagnostic findings
Normal
Reference
Reference
-
Reference
-
Angioectasia
Reference
1.97 (0.69-5.6)
0.202
7.7 (2.81-21.14)
< 0.001
Erosion/ulcer/other
Reference
0.93 (0.37-2.32)
0.871
1.13 (0.40-3.23)
0.815
Diagnostic yield
Reference
1.25 (0.57-2.73)
0.584
3.02 (1.32-6.93)
0.009
Intervention
Reference
1.10 (0.50-2.45)
0.808
2.69 (1.23-5.9)
0.013
Depth of the scope-RC (95%CI)
Reference
-11.26 (-33.15 to 10.63)
0.311
13.52 (-8.57 to 35.62)
0.229
Retrograde
Diagnostic findings
Normal
Reference
Reference
-
Reference
-
Erosion/ulcer/other
Reference
3.25 (0.35-30.05)
0.299
1.29 (0.11-15.32)
0.84
Diagnostic yield
Reference
3.75 (0.4-34.8)
0.245
1.73 (0.18-16.82)
0.639
Intervention
Reference
2.07 (0.13-33.57)
0.608
11.97 (0.76-187.64)
0.077
Depth of the scope-RC (95%CI)
Reference
-16.47 (-88.39 to 55.45)
0.639
31.19 (-45.01 to 107.39)
0.404
Differences in the outcomes between age groups among retrograde SBE patients: The mean estimated depth of insertion was 107 cm proximal to the ileocecal valve with no significant difference between age groups (117, 73, 134 cm, P = 0.26) (Table 4). Diagnostic yield was 48.2% with no difference between age groups (45.5%, 55.6%, 42.9%, P = 0.86). The most common finding was ulcer/erosion in 5 (18.5%) with only 1 angioectasia (3.7%). Interventions were done in 24.2% with no difference between age groups (15.4%, 16.7%, 50.0%, P = 0.15). Therapeutic yield was 15.2% with significantly higher in elderly group (0, 8.3, 50%, P = 0.006). Both complications occurred with antegrade enteroscopy and none with retrograde. After adjusting for BMI, gender, ethnicity, and indication, no differences in diagnostic yield, intervention, or depth of scope were noticed across groups (Table 5). However, a trend towards higher use of intervention was observed in the very elderly group (OR = 11.97; 95%CI: 0.76-187.64, P = 0.077) in the adjusted analysis (Table 5).
DISCUSSION
Our study found that SBE can be done safely in the elderly. The elderly were more likely to have the indication of GI bleeding, as opposed to IDA, than the other groups. Diagnostic yield and interventions were significantly higher in the elderly group and angioectasias were the most common finding. Antegrade SBE was more commonly performed than retrograde in our entire cohort. Most differences seen in the elderly were present only in the group with the antegrade route rather than the smaller retrograde group. We also found that the depth of maximal insertion for both antegrade and retrograde procedures, was not different in the elderly.
Reviews of DAE in the elderly have largely focused on DBE[15,21-23,29-32] although studies on SBE have been included. In a systematic review and meta-analysis of DAE in patients 65 years and older, compared with younger patients, Zammit et al[21] included 14 studies mostly DBE with 2 SBE. The overall diagnostic yield in the elderly was 68%, DBE: 67%, SBE: 68% and overall therapeutic yield 45%, DBE: 46%, SBE: 46%, Pooled major adverse events was DBE: 2% defined as cardiovascular complications, intestinal bleeding, acute pancreatitis, perforation, aspiration pneumonia or death. There was no significant difference in the occurrence of major adverse events in elderly compared with younger patients. The diagnostic yield of 1.83 favoring the elderly (diagnostic yield of DBE: 1.74, diagnostic yield of SBE: 1.90). Overall, therapeutic yield was 2.28 favoring elderly patients (DBE: 2.20 and SBE: 2.36). The most common indication for DAE in both elderly and young patients (78.8% elderly, 71.6% young) was obscure GI bleed. Angioectasia were the most common finding in the elderly (32.7%). They concluded that DAE had a higher diagnostic yield and therapeutic yield in the elderly compared with younger patients and could be done safely, similar to our results with SBE.
Another review of enteroscopy in the elderly noted reported diagnostic yields of 40-80% for DBE and 36%-66% for SBE, similar despite the potentially longer insertion capability of DBE with a reported diagnostic yield in the elderly of 53%-92%. Therapeutic yield for DAE was 4%-48% for SBE and 9%-92% for DBE and in the elderly 23%-59%, significantly higher in the elderly in some studies. Complication rates range from 0.4%-5% for DBE and 0.6% to 5.5% for SBE, while results for complication rates in the elderly have been variable[15]. Our results with SBE are in line with these, although our complication rate may have been lower. There are only a few studies on SBE in the elderly (Table 6)[33-35].
Table 6 Studies of single-balloon enteroscopy in the elderly.
Angiodysplasia and diverticulum TY high in the elderly
Safe, no diff in complications
This study
TX, United States
2011-2020
228
< 65, 65-75
OGIB
DY higher in the elderly
> 75
IDA
Main finding was angioectasias
TY higher in the very elderly, safe
The findings in our study are in line with these as noted above, although the data are analyzed somewhat differently. Davis-Yadley et al[33] evaluated the safety and efficacy of SBE with comparison of 3 older patient groups with patients younger than 55 years (under 55 years, 55-64 years, 65-74 years, over 75 years). Diagnostic yield was highest in the elderly (50.0%, 55.6%, 59.7%, 66.3%), significantly higher for age greater than or equal to 75 compared with the youngest group. Angioectasias were the most common finding in all age groups, increasing with age (13.6%, 30.0%, 37.0%, 39.6%). Therapeutic yield was higher in the 3 elderly groups compared with the younger (20.3%, 44.4%, 42.0%, 47.5%), with argon plasma coagulation and multipolar electrocoagulation used more often in the older age groups. There were few complications and no difference between age groups[33]. The study by Lin et al[34] was not primarily a study of enteroscopy in the elderly, but was a sub-analysis of an experience with SBE at a tertiary care hospital in Taiwan, with patients stratified into 3 groups (under 30, 30-65, over 65). The most frequent indication for SBE was obscure GI bleed. The most common etiology in the older age groups was angiodysplasia (5.9%, 19.2%, 27.0%)[34]. Another retrospective study of SBE in elderly patients from a Taiwan tertiary care hospital by Chang et al[35], looked at antegrade and retrograde SBE in 2 age groups, less than 65 years, and greater than or equal to 65 years. Elderly patients were more likely to have the indication of GI bleeding (83.9% vs 36.6%) and had a higher diagnostic yield (75% vs 51.8%) and therapeutic yield (39.3% vs 16.9%). Elderly patients were more frequently found to have angiodysplasia (37.5% vs 8%) or a diverticulum (25% vs 3.6%)[35].
Our study has some limitations. The study was retrospective with clinical data from a single experienced endoscopist at a single institution. Sample size was moderate and comparable to that of previous studies. Results may have limited generalizability to those of centers seeing a different type of patient population, such as a referral center for cancer patients. Long-term outcome data were not obtained; therefore, the impact of the diagnostic yield may not be estimated in our study. Additionally, as only SBE was available at our institution, there was no direct comparison between SBE and DBE. Strengths are that this is only the second United States study to specifically look at SBE in the elderly and used 3 comparison age groups in a Hispanic and non-Hispanic population.
CONCLUSION
In conclusion, in a retrospective analysis of SBE, we found this procedure safe and feasible in the elderly. SBE should be performed taking into account comorbidities and overall anesthesia risk for a potentially time-consuming procedure. SBE has a higher diagnostic and therapeutic outcome in the elderly compared to other age groups, largely due to the increased chance of detecting small bowel haemangiomas.
ACKNOWLEDGEMENTS
The preliminary results of this project were partially presented as an abstract at the American College of Gastroenterology Virtual Meeting in October, 2020[36].
Footnotes
Provenance and peer review: Unsolicited article; Externally peer reviewed.
Peer-review model: Single blind
Corresponding Author’s Membership in Professional Societies: American Gastroenterological Association.
Specialty type: Gastroenterology and hepatology
Country of origin: United States
Peer-review report’s classification
Scientific Quality: Grade C
Novelty: Grade C
Creativity or Innovation: Grade C
Scientific Significance: Grade B
P-Reviewer: Matsui T S-Editor: Bai Y L-Editor: A P-Editor: Zhang L
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