• double-balloon enteroscopy
• small-bowel neuroendocrine tumours
• video capsule endoscopy

• Angioectasias
• Device-assisted enteroscopy
• Dieulafoy lesions
• Endoscopic therapy
• Push enteroscopy
• Small bowel bleeding
• Small bowel capsule endoscopy

• Humans
• Endoscopy, Gastrointestinal/adverse effects
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/surgery
• Intestine, Small/surgery
• Capsule Endoscopy
• Epinephrine/therapeutic use

• Arteriovenous malformations
• Enteroscopy
• Management
• Speed

• Double-balloon enteroscopy
• Small bowel disease
• Small bowel resection

• Double-Balloon Enteroscopy/methods
• Gastrointestinal Hemorrhage/etiology
• Humans
• Intestinal Diseases/surgery
• Intestine, Small/pathology
• Intestine, Small/surgery
• Retrospective Studies

For patients with obscure gastrointestinal bleeding (OGIB), finding the bleeding site is challenging. Balloon-assisted enteroscopy (BAE) has become the preferred diagnostic modality for OGIB. The long-term outcome of patients with negative BAE remains undefined. The present study aimed to evaluate the long-term outcomes of patients with negative BAE results for OGIB and to clarify the effect of further investigations at the time of rebleeding with a systematic review and meta-analysis of the available cohort studies.

Studies were searched through the PubMed, EMBASE, and Cochrane library databases. The following indexes were analyzed: rebleeding rate after negative BAE, rebleeding rate after different follow-up periods, the proportion of patients who underwent further evaluation after rebleeding, the percentage of patients with identified rebleeding sources, and the percentage of patients with rebleeding sources in the small intestine. Heterogeneity was assessed using the I² test.

Twelve studies that involved a total of 407 patients were included in the analysis. The pooled rebleeding rate after negative BAE for OGIB was 29.1% (95% CI: 17.2–42.6%). Heterogeneity was significant among the studies (I² = 88%; p < 0.0001). The Chi-squared test did not show a difference in rebleeding rates between the short and long follow-up period groups (p = 0.142). The pooled proportion of patients who underwent further evaluation after rebleeding was 86.1%. Among the patients who underwent further evaluation, rebleeding sources were identified in 73.6% of patients, and 68.8% of the identified rebleeding lesions were in the small intestine.

A negative result of BAE in patients with OGIB indicates a subsequently low risk of rebleeding. Further evaluation should be considered after rebleeding.

• Capsule endoscopy
• Double balloon enteroscopy
• Enteroscopy
• Small bowel bleeding

• Capsule endoscopy
• Double-balloon enteroscopy
• Enteroscopy
• Neuroendocrine neoplasms
• Small bowel

Single-balloon enteroscopy (SBE) has been widely used in diagnosing small bowel disease. We conducted this study to systematically appraise its technical and clinical performance.

Studies on SBE published by September 2018 were systematically searched. Technical and clinical performance data were collected and analyzed with descriptive or meta-analysis methods.

In total, 54 articles incorporating 4,592 patients (6,036 procedures) were included. Regarding technical parameters, the pooled insertion depths (IDs) for anterograde and retrograde SBE were 209.2 cm and 98.1 cm, respectively. The pooled retrograde ID in Asian countries was significantly greater than that in Western countries (129.0 cm vs 81.1 cm, p<0.001). The pooled anterograde and retrograde procedure times were 57.6 minutes and 65.1 minutes, respectively. The total enteroscopy rate was 21.9%, with no significant difference between Asian and Western countries. Clinically, the pooled diagnostic yield of SBE was 62.3%. Obscure gastrointestinal bleeding (OGIB) was the most common indication (50.0%), with a diagnostic yield of 59.5%. Vascular lesions were the most common findings in Western OGIB patients (76.9%) but not in Asian ones (31.0%). The rates of severe and mild adverse events were 0.5% and 2.5%, respectively.

SBE is technically efficient and is clinically effective and safe, but total enteroscopy is relatively difficult to achieve with this technique. Etiologies of OGIB in Asian countries differ from those in Western countries.

• Diagnosis
• Meta-analysis
• Single-balloon enteroscopy
• Systematic review
• Total enteroscopy

Double-balloon enteroscopy (DBE) is widely used worldwide. However, comparisons between the diagnostic yields in adults and the elderly remain scarce.

The aim of this study is to compare the diagnostic yields and safety of DBE between adults and elderly with obscure gastrointestinal bleeding and incomplete small bowel obstruction.

We retrospectively reviewed patients who underwent DBE with indication of obscure gastrointestinal bleeding or incomplete small bowel obstruction in Ruijin Hospital and classified them into adults (18–64 years old) and elderly (≥65 years old). Clinical characteristics, diagnostic yields, and postoperative complications were collected and further analyzed.

A total of 877 DBE procedures, 729 in adults and 148 in the elderly, were performed. In the patients with OGIB, the adults showed a higher frequency of Meckel's diverticulum compared with the elderly (4.6% vs. 0.9%, P = 0.032). Angioectasia was higher in frequency in the elderly than in the adults (25.9% vs. 17.9%, P = 0.048). In patients with incomplete small bowel obstruction, the elderly were more likely to have adenocarcinoma than the adults (19.4% vs. 7.1%, P = 0.038). The adults had higher tendency to have Crohn's disease than the elderly (23.4% vs. 8.3%, P = 0.045). Most of the postoperative complications were mild. The adults and elderly displayed comparable tolerance to DBE (P > 0.05)

DBE has a high diagnostic yield in small bowel disorders, and a slight difference in disease spectrum was observed between the adults and elderly. DBE can be well-tolerated in the elderly.

• Complication
• Diagnostic yield
• Double-balloon enteroscopy
• Small bowel disease
• Therapeutic intervention

• Double-balloon enteroscopy
• Gastrointestinal hemorrhage
• Outcome research
• Small intestine

• Double-balloon enteroscopy
• Pediatric
• Suspected small-bowel bleeding
• Taiwan

• DBE
• advanced endoscopy
• anaesthesia
• device assisted enteroscopy
• double balloon enteroscopy
• elderly
• propofol
• safety
• sedation

• China
• double-balloon enteroscopy
• etiology
• obscure gastrointestinal hemorrhage
• single-balloon enteroscopy

• Anemia, Iron-Deficiency/etiology
• Angiography
• Balloon Enteroscopy
• Capsule Endoscopy
• Colonoscopy
• Duodenal Diseases/diagnostic imaging
• Endoscopy, Gastrointestinal
• Gastrointestinal Hemorrhage/diagnostic imaging
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/therapy
• Humans
• Ileal Diseases/diagnostic imaging
• Jejunal Diseases/diagnostic imaging
• Magnetic Resonance Imaging
• Tomography, X-Ray Computed

• CT enterography
• CT-enteroclysis
• Capsule endoscopy
• Device-assisted enteroscopy
• MR enterography
• MR-enteroclysis
• Small bowel tumors

• Balloon-assisted enteroscopy
• Complete enteroscopy
• Diagnostic DBE
• Double-balloon enteroscopy (DBE)
• Midgastrointestinal bleeding (MGIB)
• Therapeutic DBE

• Acute pancreatitis
• Deep enteroscopy
• Device assisted endoscopy
• Double balloon enteroscopy
• Hyperamylasemia
• Small intestinal disorders

• Neuroendocrine tumors
• capsule endoscopy
• double-balloon enteroscopy
• small bowel

• balloon-assisted enteroscopy
• complication rate
• diagnostic yield
• double balloon enteroscopy
• indication
• single balloon enteroscopy

Advances in technology have facilitated the common use of small-bowel imaging. Intraoperative enteroscopy was the gold standard method for small-bowel imaging. However, noninvasive capsule endoscopy and invasive balloon enteroscopy are currently the main endoscopic procedures that are routinely used for small-bowel pathologies, and the indications for both techniques are similar. Although obstruction is a contraindication for capsule endoscopy, it is not considered to be problematic for double-balloon enteroscopy. The most important advantage of double-balloon enteroscopy is the applicability of therapeutic interventions during the procedure; however, double-balloon enteroscopy has certain advantages as well as disadvantages.

• Double-balloon enteroscopy
• Small bowel

• Balloon-assisted
• Children
• Double-balloon
• Enteroscopy
• Pediatric
• Single-balloon
• Small bowel

Obscure gastrointestinal bleeding (OGIB) is defined as recurrent or persistent bleeding or presence of iron deficiency anaemia after evaluation with a negative bidirectional endoscopy. OGIB accounts for 5% of gastrointestinal bleeding and presents a diagnostic challenge. Current modalities available for the investigation of OGIB include capsule endoscopy, balloon assisted enteroscopy, spiral enteroscopy and computed tomography enterography. These modalities overcome the limitations of previous techniques. Following a negative bidirectional endoscopy, capsule endoscopy and double balloon enteroscopy remain the cornerstone of investigation in OGIB given their high diagnostic yield. Long-term outcome data in patients with OGIB is limited, but is most promising for capsule endoscopy. This article reviews the current literature and provides an overview of the clinical evaluation of patients with OGIB, available diagnostic and therapeutic modalities and long-term clinical outcomes.

• Obscure gastrointestinal bleeding
• Capsule endoscopy
• Double balloon enteroscopy
• Outcomes
• Anaemia

• capsule endoscopy
• small bowel Crohn’s disease
• wireless capsule technology

Providers may be hesitant to perform double-balloon enteroscopy (DBE) in the elderly because the increased number of co-morbidities in this population poses a greater risk of complications resulting from sedation. There are limited data on the use of DBE in the elderly. Here, we assessed the safety and efficacy of DBE in the elderly compared to those in younger patients.

We retrospectively analyzed the medical records of 158 patients who underwent 218 DBEs. Patients were divided into an elderly group (age ≥65 years; mean 71.4±5.4; n=34; 41 DBEs) and a younger group (age <65 years; mean 39.5±13.5; n=124; 177 DBEs).

In both groups, the most common indication for DBE was obscure gastrointestinal bleeding. Mucosal lesions (33.3% vs. 60.9%; P=0.002) were the most common finding in both groups, followed by tumors (30.8% vs. 14.1%; P=0.036). The elderly were more likely to receive interventional therapy (51.3% vs. 23.5%; P=0.001). The diagnostic yield of DBE was slightly higher in the elderly group (92.3% vs. 86.5%; P=0.422), but was not statistically significant. The therapeutic success rate of DBE was 100% in the elderly group compared to 87.5% in the younger group (P=0.536). The overall DBE complication rate was 1.8% overall, and this rate did not differ significantly between the groups (2.6% vs. 1.7%; P=0.548).

DBE is safe and effective in the elderly, and has a high diagnostic yield and high therapeutic success rate.

• Double-balloon enteroscopy
• Efficacy
• Elderly
• Safety

Enteroscopy, defined as direct visualization of the small bowel with the use of a fiberoptic or capsule endoscopy, has progressed considerably over the past several years. The need for endoscopic access to improve diagnosis and treatment of small bowel disease has led to the development of novel technologies one of which is non-invasive, the video capsule, and a type of invasive technique, the device-assisted enteroscopy. In particular, the device-assisted enteroscopy consists then of three different types of instruments all able to allow, in skilled hands, to display partially or throughout its extension (if necessary) the small intestine. Newer devices, double balloon, single balloon and spiral endoscopy, are just entering clinical use. The aim of this article is to review recent advances in small bowel enteroscopy, focusing on indications, modifications to improve imaging and techniques, pitfalls, and clinical applications of the new instruments. With new technologies, the trials and tribulations of learning new endoscopic skills and determining their role in the diagnosis and treatment of small bowel disease come. Identification of small bowel lesions has dramatically improved. Studies are underway to determine the best strategy to apply new enteroscopy technologies for the diagnosis and management of small bowel disease, particularly obscure bleeding. Vascular malformations such as angiectasis and small bowel neoplasms as adenocarcinoma or gastrointestinal stromal tumors. Complete enteroscopy of the small bowel is now possible. However, because of the length of the small bowel, endoscopic examination and therapeutic maneuvers require significant skill, radiological assistance, the use of deep sedation with the assistance of the anesthetist. Prospective randomized studies are needed to guide diagnostic testing and therapy with these new endoscopic techniques.

• Device-assisted enteroscopy
• Double balloon
• Single balloon
• Spiral endoscopy

AIM: To evaluate the diagnostic yield and therapeutic impact of double-balloon endoscopy (DBE) in patients with incomplete intestinal obstruction.

METHODS: From April 2004 to September 2011, DBE was preformed in 107 patients with incomplete intestinal obstruction. Some of them underwent DBE treatment.

RESULTS: A total of 189 DBE procedures (122 via an oral approach, 67 via an anal approach, 45 via both approaches) were performed in 107 patients with incomplete intestinal obstruction. DBE identified the causes of intestinal obstruction in 98 patients (91.6%). Sixty-four patients (56 patients having Peutz-Jeghers syndrome with huge polyps and 8 patients having benign stricture of the small intestine) underwent 175 DBE endoscopic treatments: polypectomies (n = 167) for huge polyps and dilation therapy (n = 8) for entero stenosis. After therapeutic endoscopy, the symptoms of intestinal obstruction disappeared or were alleviated in 50 patients (78.1%, 45 cases undergoing polypectomy and 5 cases undergoing dilation therapy). Among 189 DBE procedures, five cases of serious complications (2.7%, three cases of small intestine perforation and two cases of bleeding with a fall in Hb) occurred.

CONCLUSION: DBE has a high diagnosis rate in patients with incomplete intestinal obstruction and provides a treatment to some patients to avoid unnecessary abdominal surgery.

• Double-balloon endoscopy
• Intestinal obstruction
• Diagnosis
• Treatment

AIM: To assess the diagnostic success and outcome among patients with obscure gastrointestinal bleeding who underwent total enteroscopy with double-balloon endoscopy.

METHODS: Total enteroscopy was attempted in 156 patients between August 2003 and June 2008 at Hiroshima University Hospital and achieved in 75 (48.1%). It is assessed whether sources of bleeding were identified, treatment methods, complications, and 1-year outcomes (including re-bleeding) after treatment, and we compared re-bleeding rates among patients.

RESULTS: The source of small bowel bleeding was identified in 36 (48.0%) of the 75 total enteroscopy patients; the source was outside the small bowel in 11 patients (14.7%) and not identified in 28 patients (37.3%). Sixty-one of the 75 patients were followed up for more than 1 year (27.2 ± 13.3 mo). Four (6.6%) of these patients showed signs of re-bleeding during the first year, but bleeding did not recur after treatment. Although statistical significance was not reached, a marked difference was found in the re-bleeding rate between patients in whom total enteroscopy findings were positive (8.6%, 3/35) and negative (3.8%, 1/26) (3/35 vs 1/26, P = 0.63).

CONCLUSION: A good outcome can be expected for patients who undergo total enteroscopy and receive proper treatment for the source of bleeding in the small bowel.

• Double-balloon endoscopy
• Small bowel
• Obscure gastrointestinal bleeding
• Total enteroscopy
• Outcome

• Endoscopic surgery

• Crohn's disease
• double-balloon endoscopy
• endoscopic-balloon dilation