Single balloon enteroscopy in the elderly

Table 1 Demographics and clinical characteristics of patients in the entire cohort and by age groups, n (%)

Factor	Entire cohort (n = 227)	Age (years)			P value
		< 65 (n = 117)	65-75 (n = 57)	> 75 (n = 53)
Age (years), mean ± SD	61.9 ± 16.7	49.4 ± 13.1	69.5 ± 3.1	81.3 ± 3.8	-
BMI (kg/m2), mean ± SD	28.0 ± 6.3	28.4 ± 6.2	28.2 ± 7.2	26.9 ± 5.3	0.33
Gender					0.86
Female	130 (57.27)	69 (58.97)	32 (56.14)	29 (54.72)
Male	97 (42.73)	48 (41.03)	25 (43.86)	24 (45.28)
Ethnicity					0.14
Non-Hispanic	128 (56.64)	73 (62.93)	29 (50.88)	26 (49.06)
Hispanic	98 (43.36)	43 (37.07)	28 (49.12)	27 (50.94)
Indication of enteroscopy
GI bleeding	109 (48.02)	50 (42.74)	23 (40.35)	36 (67.92)	0.004
Abdominal pain	32 (14.10)	28 (23.93)	2 (3.51)	2 (3.77)	< 0.001
Iron deficiency anemia	109 (48.02)	52 (44.44)	32 (56.14)	25 (47.17)	0.35
Others1	110 (48.46)	57 (48.72)	32 (56.14)	21 (39.62)	0.22
Number of indications					0.74
1	99 (43.61)	52 (44.44)	25 (43.86)	22 (41.51)
2	88 (38.77)	42 (35.90)	25 (43.86)	21 (39.62)
≥ 3	40 (17.62)	23 (19.66)	7 (12.28)	10 (18.87)
Prior video capsule	160 (70.80)	78 (67.24)	44 (77.19)	38 (71.70)	0.39
Route					0.22
Antegrade	194 (85.46)	104 (88.89)	45 (78.95)	45 (84.91)
Retrograde	33 (14.54)	13 (11.11)	12 (21.05)	8 (15.09)
Bypass-yes	19 (8.37)	13 (11.11)	4 (7.02)	2 (3.77)	0.29

¹Others include abnormal capsule (n = 98), abnormal imaging (n = 24), diarrhea (n = 12), weight loss (n = 1), possible bile leak (n = 1), melena (n = 1).

BMI: Body mass index; GI: Gastrointestinal.

Table 2 Differences in the outcomes between age groups among single-balloon enteroscopy patients

Factor	Entire cohort (n = 227)	Age (years)			P value
		< 65 (n = 117)	65-75 (n = 57)	> 75 (n = 53)
Diagnostic findings1					< 0.001
Normal	98 (45.79)	57 (51.82)	25 (46.30)	16 (32.00)
Angioectasia	45 (21.03)	12 (10.91)	11 (20.37)	22 (44.00)
Erosion/ulcer	23 (10.75)	14 (12.73)	7 (12.96)	2 (4.00)
Other2	48 (22.43)	27 (24.55)	11 (20.37)	10 (20.00)
Diagnostic yield	116 (54.21)	53 (48.18)	29 (53.70)	34 (68.00)	0.066a
Intervention	91 (40.09)	41 (35.04)	19 (33.33)	31 (58.49)	0.007b
Therapeutic yield	56 (24.67)	17 (14.53)	12 (21.05)	27 (50.94)	< 0.001b
Complications	2 (0.88)	1 (0.85)	0 (0.00)	1 (1.89)	0.57

^aP < 0.05 for < 65 vs > 75.

^bP < 0.05 for 65-75 vs > 75.

¹13 had missing data.

²The other diagnostic yield 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), and miscellaneous (n = 9).

Therapeutic yield includes all therapeutic interventions excluding tissue sampling and polypectomy. Complications (n = 2) included minor oropharyngeal hemorrhage (n = 1), and minor esophageal trauma (n = 1).

Table 3 Adjusted differences in the outcomes by age groups

Characteristics	Age (years)
	< 65	65-75		> 75
		OR (95%CI)	P value	OR (95%CI)	P value
Diagnostic findings
Normal (reference)	Reference	Reference	-	Reference	-
Angioectasia	Reference	2.25 (0.85-5.95)	0.102	7.16 (2.79-18.38)	< 0.001
Erosion/ulcer	Reference	1.1 (0.38-3.19)	0.856	0.43 (0.09-2.2)	0.313
Other1	Reference	1.04 (0.43-2.52)	0.922	1.33 (0.5-3.54)	0.575
Diagnostic yield	Reference	1.37 (0.69-2.7)	0.365	2.38 (1.14-4.96)	0.021
Intervention	Reference	1.13 (0.56-2.28)	0.742	3.15 (1.54-6.47)	0.002
Depth of the scope, RC (95%CI)	Reference	-19.02 (-39.57 to 1.52)	0.069	16.29 (-4.82 to 37.41)	0.130

¹The other diagnostic yield 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), and miscellaneous (n = 9).

Adjusted for body mass index, gender, ethnicity, route, and indication. CI: Confidence interval; OR: Odds ratio, RC: Regression coefficient.

Table 4 Differences in the outcomes between age groups among single-balloon enteroscopy patients by type of single-balloon enteroscopy

Factor	Entire cohort (n = 194)	Age (years)			P value
		< 65 (n = 104)	65-75 (n = 45)	> 75 (n = 45)
Depth of the scope, mean ± SD, n = 178	227.1 (59.1)	227.3 (60.4)	211.9 (54.2)	242.1 (58.2)	0.060
Diagnostic findings1					< 0.001
Normal	84 (44.92)	51 (51.52)	21 (46.67)	12 (27.91)
Angioectasia	44 (23.53)	12 (12.12)	11 (24.44)	21 (48.84)
Erosion/ulcer	18 (9.63)	13 (13.13)	4 (8.89)	1 (2.33)
Other	41 (21.93)	23 (23.23)	9 (20.00)	9 (20.93)
Diagnostic yield	103 (55.08)	48 (48.48)	24 (53.33)	31 (72.09)	0.033
Intervention	83 (42.78)	39 (37.50)	17 (37.78)	27 (60.00)	0.029
Therapeutic yield	51 (26.29)	17 (16.35)	11 (24.44)	23 (51.11)	< 0.001
Complications	2 (1.03)	1 (0.96)	0 (0.00)	1 (2.22)	0.58
Retrograde	33	13	12	8	-
Depth of the scope, mean ± SD, n = 30	106.9 (82.1)	117.1 (82.7)	73.1 (63.2)	133.8 (97.2)	0.26
Diagnostic findings1					0.48
Normal	14 (51.85)	6 (54.55)	4 (44.44)	4 (57.14)
Angioectasia	1 (3.70)	0 (0.00)	0 (0.00)	1 (14.29)
Erosion/ulcer	5 (18.52)	1 (9.09)	3 (33.33)	1 (14.29)
Other	7 (25.93)	4 (36.36)	2 (22.22)	1 (14.29)
Diagnostic yield	13 (48.15)	5 (45.45)	5 (55.56)	3 (42.86)	0.86
Intervention	8 (24.24)	2 (15.38)	2 (16.67)	4 (50.00)	0.15
Therapeutic yield	5 (15.15)	0 (0.00)	1 (8.33)	4 (50.00)	0.006
Complications	0	0	0	0	-

¹13 had missing data (7 in antegrade and 6 in retrograde).

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

Adjusted for body mass index, gender, ethnicity, and indication. OR: Odds ratio; CI: Confidence interval; RC: Regression coefficient.

Table 6 Studies of single-balloon enteroscopy in the elderly

Ref.	Country	Time period	No. Pts.	Age groups, years	Main indication	Main findings
Davis-Yadley et al[33], 2016	FL, United States	2010-2014	366	< 55, 55-64	OGIB	DY highest in elderly
				65-74, ≥ 75		Angiodysplasia most common in elderly
						TY higher in elderly
						Safe, few complications
Lin et al[34], 2016	Taiwan	2009-2014	128	< 30, 30-65	OGIB	The most common finding in the older age group was angiodysplasia
				> 65
Chang et al[35], 2017	Taiwan	2009-2016	168	< 65, ≥ 65	OGIB	DY high 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

All studies were retrospective cohort studies. Most had primary analysis on elderly, Lin only for findings. DY: Diagnostic yield; IDA: Iron deficiency anemia; OGIB: Obscure gastrointestinal bleed; TY: Therapeutic yield.