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• W1694166411 abstract "This is one of a series of position statements discussing the use of GI endoscopy in common clinical situations. The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy (ASGE) prepared this text. In preparing this article, MEDLINE and PubMed databases were used to search for publications between January 1975 and December 2013 pertaining to this topic. The search was supplemented by accessing the ‘‘related articles’’ feature of PubMed, with articles identified on MEDLINE and PubMed as the references. Additional references were obtained from the bibliographies of the identified articles and from recommendations of expert consultants. When few or no data were available from well-designed prospective trials, emphasis was given to results from large series and reports from recognized experts. Weaker recommendations are indicated by phrases such as “We suggest…” whereas stronger recommendations are stated as “We recommend….” The strength of individual recommendations was based on both the aggregate evidence quality (Table 1)1Guyatt G.H. Oxman A.D. Vist G.E. et al.GRADE: an emerging consensus on rating quality of evidence and strength of recommendations.BMJ. 2008; 336: 924-926Crossref PubMed Google Scholarand an assessment of the anticipated benefits and harms.Table 1GRADE system for the quality of evidence for guidelinesAdapted from Guyatt et al.1Guyatt G.H. Oxman A.D. Vist G.E. et al.GRADE: an emerging consensus on rating quality of evidence and strength of recommendations.BMJ. 2008; 336: 924-926Crossref PubMed Google ScholarQuality of evidenceDefinitionSymbolHigh qualityFurther research is very unlikely to change our confidence in the estimate of effect.⊕⊕⊕⊕Moderate qualityFurther research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.⊕⊕⊕○Low qualityFurther research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.⊕⊕○○Very low qualityAny estimate of effect is very uncertain.⊕○○○GRADE, Grading of Recommendations Assessment, Development and Evaluation. Open table in a new tab GRADE, Grading of Recommendations Assessment, Development and Evaluation. ASGE position statements for appropriate use of endoscopy are based on a critical review of the available data and expert consensus at the time that the documents are drafted. Further controlled clinical studies may be needed to clarify aspects of this document. This document may be revised as necessary to account for changes in technology, new data, or other aspects of clinical practice and is solely intended to be an educational device to provide information that may assist endoscopists in providing care to patients. This document is not a rule and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment. Clinical decisions in any particular case involve a complex analysis of the patient’s condition and available courses of action. Therefore, clinical considerations may lead an endoscopist to take a course of action that varies from the recommendations and suggestions proposed in this document. The diagnosis and treatment of small-bowel disorders is challenging because of the length of the small intestine, its anatomy, and the lack of appropriate tools. However, the introduction of video capsule endoscopy2Iddan G. Meron G. Glukhovsky A. et al.Wireless capsule endoscopy.Nature. 2000; 405: 417Crossref PubMed Scopus (2523) Google Scholar, 3Meron G.D. The development of the swallowable video capsule (M2A).Gastrointest Endosc. 2000; 52: 817-819Abstract Full Text Full Text PDF PubMed Scopus (277) Google Scholar (VCE) and deep enteroscopy4Yamamoto H. Sekine Y. Sato Y. et al.Total enteroscopy with a nonsurgical steerable double-balloon method.Gastrointest Endosc. 2001; 53: 216-220Abstract Full Text Full Text PDF PubMed Scopus (1185) Google Scholar (DE) has changed the management of these patients. Although VCE can theoretically visualize the entire small intestine, it is unable to obtain biopsy specimens, cross altered anatomy, or perform therapeutic interventions. DE, on the other hand, has become the technique of choice for tissue acquisition or therapeutic intent within the GI tract between the ampulla of Vater and the ileocecal valve, a region referred to as the mid-gut.5Ell C. May A. Mid-gastrointestinal bleeding: capsule endoscopy and push-and-pull enteroscopy give rise to a new medical term.Endoscopy. 2006; 38: 73-75Crossref PubMed Scopus (112) Google Scholar DE techniques, which include double-balloon enteroscopy (DBE), single-balloon enteroscopy (SBE), and spiral enteroscopy (SE), have both diagnostic and therapeutic capabilities. DBE was first introduced by Yamamoto et al4Yamamoto H. Sekine Y. Sato Y. et al.Total enteroscopy with a nonsurgical steerable double-balloon method.Gastrointest Endosc. 2001; 53: 216-220Abstract Full Text Full Text PDF PubMed Scopus (1185) Google Scholar in 2001 and is the most studied and established DE technique to date. Multiple studies have evaluated the usefulness of DBE for the diagnosis and management of different small-bowel conditions, particularly obscure GI bleeding (OGIB).6Yamamoto H. Kita H. Sunada K. et al.Clinical outcomes of double-balloon endoscopy for the diagnosis and treatment of small-intestinal diseases.Clin Gastroenterol Hepatol. 2004; 2: 1010-1016Abstract Full Text Full Text PDF PubMed Scopus (644) Google Scholar, 7May A. Nachbar L. Schneider M. et al.Prospective comparison of push enteroscopy and push-and-pull enteroscopy in patients with suspected small-bowel bleeding.Am J Gastroenterol. 2006; 101: 2016-2024Crossref PubMed Scopus (121) Google Scholar, 8Mehdizadeh S. Ross A. Gerson L. et al.What is the learning curve associated with double-balloon enteroscopy? Technical details and early experience in 6 U.S. tertiary care centers.Gastrointest Endosc. 2006; 64: 740-750Abstract Full Text Full Text PDF PubMed Scopus (256) Google Scholar, 9Khashab M. Helper D.J. Johnson C.S. et al.Predictors of depth of maximal insertion at double-balloon enteroscopy.Dig Dis Sci. 2010; 55: 1391-1395Crossref PubMed Scopus (16) Google Scholar SBE and SE are more recent modalities in endoscopic evaluation of the small intestine. SBE was introduced to streamline the technique of push-and-pull enteroscopy.10Tsujikawa T. Saitoh Y. Andoh A. et al.Novel single-balloon enteroscopy for diagnosis and treatment of the small intestine: preliminary experiences.Endoscopy. 2008; 40: 11-15Crossref PubMed Scopus (291) Google Scholar, 11Kawamura T. Yasuda K. Tanaka K. et al.Clinical evaluation of a newly developed single-balloon enteroscope.Gastrointest Endosc. 2008; 68: 1112-1116Abstract Full Text Full Text PDF PubMed Scopus (137) Google Scholar, 12Ramchandani M. Reddy D.N. Gupta R. et al.Diagnostic yield and therapeutic impact of single-balloon enteroscopy: series of 106 cases.J Gastroenterol Hepatol. 2009; 24: 1631-1638Crossref PubMed Scopus (106) Google Scholar The potential benefits of SBE over DBE include shorter set-up time, a 1-balloon cycle requirement instead of 2, a less burdensome balloon control panel, and the use of a non-latex balloon.13Upchurch B.R. Vargo J.J. Single-balloon enteroscopy.Gastrointest Endosc Clin N Am. 2009; 19: 335-347Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar SE permits evaluation of the small intestine by a rotate-to-advance technology. Its potential benefits include swift small-bowel examination, stability within the small bowel, and meticulous examination of the intestinal mucosa on both insertion and withdrawal of the enteroscope.14Akerman P.A. Agrawal D. Chen W. et al.Spiral enteroscopy: a novel method of enteroscopy by using the Endo-Ease Discovery SB overtube and a pediatric colonoscope.Gastrointest Endosc. 2009; 69: 327-332Abstract Full Text Full Text PDF PubMed Scopus (98) Google Scholar, 15Akerman P.A. Agrawal D. Cantero D. et al.Spiral enteroscopy with the new DSB overtube: a novel technique for deep peroral small-bowel intubation.Endoscopy. 2008; 40: 974-978Crossref PubMed Scopus (157) Google Scholar, 16Buscaglia J.M. Dunbar K.B. Okolo 3rd, P.I. et al.The spiral enteroscopy training initiative: results of a prospective study evaluating the Discovery SB overtube device during small bowel enteroscopy (with video).Endoscopy. 2009; 41: 194-199Crossref PubMed Scopus (73) Google Scholar Techniques for DE are addressed in previous documents.17DiSario J.A. Petersen B.T. Tierney W.M. et al.ASGE Technology CommitteeEnteroscopes.Gastrointest Endosc. 2007; 66: 872-880Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar A new enteroscopy device (NaviAid; Smart Medical Systems, Ra’anana, Israel) has been designed to allow DE by using a standard adult colonoscope with the aid of a novel through-the-scope balloon.18Kumbhari V. Storm A.C. Khashab M.A. et al.Deep enteroscopy with standard endoscopes using a novel through-the-scope balloon.Endoscopy. 2014; 46: 685-689Crossref PubMed Scopus (13) Google Scholar, 19Kumbhari V. Storm A.C. Okolo 3rd, P.I. et al.Efficient retrograde enteroscopy using a novel through-the-scope balloon.Surg Endosc. 2014; 28: 2745-2746Crossref PubMed Scopus (4) Google Scholar, 20Kumbhari V. Saxena P. Khashab M.A. A new through-the-scope balloon-assisted deep enteroscopy platform.Gastrointest Endosc. 2014; 79: 694Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar Limited data regarding the use of this device for DE18Kumbhari V. Storm A.C. Khashab M.A. et al.Deep enteroscopy with standard endoscopes using a novel through-the-scope balloon.Endoscopy. 2014; 46: 685-689Crossref PubMed Scopus (13) Google Scholar and additional studies are needed before recommendations can be made. The double-balloon enteroscope (Fujinon Inc, Tokyo, Japan) was introduced in 2001 as the first therapeutic DE tool. The DBE system comprises an enteroscope, an overtube, and a balloon-pump system. Three double-balloon enteroscopes currently are available and include the diagnostic (EN-450P5), therapeutic (EN-450T5), and short model (EC450-BI5) (Table 2).21Pasha S.F. Leighton J.A. Endoscopic techniques for small bowel imaging.Radiol Clin North Am. 2013; 51: 177-187Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar The short model is mainly used for difficult ileocolonoscopies, ERCP in surgically altered anatomy, or proximal small-bowel endoscopy. Its main advantage is absence of the need for specially designed accessories because standard length endoscopic accessories can be used.22Khashab M.A. Okolo 3rd, P.I. Accessing the pancreatobiliary limb and ERCP in the bariatric patient.Gastrointest Endosc Clin N Am. 2011; 21: 305-313Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar DBE may be performed in an antegrade or retrograde manner. Advancement through the small bowel is achieved with a series of cycles by using a push-and-pull technique.17DiSario J.A. Petersen B.T. Tierney W.M. et al.ASGE Technology CommitteeEnteroscopes.Gastrointest Endosc. 2007; 66: 872-880Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar By repeating this series of steps, a greater depth of small bowel can be intubated compared with push enteroscopy or ileoscopy.7May A. Nachbar L. Schneider M. et al.Prospective comparison of push enteroscopy and push-and-pull enteroscopy in patients with suspected small-bowel bleeding.Am J Gastroenterol. 2006; 101: 2016-2024Crossref PubMed Scopus (121) Google Scholar General anesthesia often is used for antegrade procedures, whereas retrograde procedures usually are performed with patients under moderate sedation. The procedure requires additional personnel for handling of the overtube. The depth of intubation with DBE ranges from 240 cm to 360 cm past the ligament of Treitz with the antegrade approach and from 102 cm to 140 cm past the ileocecal valve with the retrograde approach.7May A. Nachbar L. Schneider M. et al.Prospective comparison of push enteroscopy and push-and-pull enteroscopy in patients with suspected small-bowel bleeding.Am J Gastroenterol. 2006; 101: 2016-2024Crossref PubMed Scopus (121) Google Scholar, 8Mehdizadeh S. Ross A. Gerson L. et al.What is the learning curve associated with double-balloon enteroscopy? Technical details and early experience in 6 U.S. tertiary care centers.Gastrointest Endosc. 2006; 64: 740-750Abstract Full Text Full Text PDF PubMed Scopus (256) Google Scholar, 23Gross S.A. Stark M.E. Initial experience with double-balloon enteroscopy at a U.S. center.Gastrointest Endosc. 2008; 67: 890-897Abstract Full Text Full Text PDF PubMed Scopus (109) Google Scholar, 24May A. Nachbar L. Ell C. Double-balloon enteroscopy (push-and-pull enteroscopy) of the small bowel: feasibility and diagnostic and therapeutic yield in patients with suspected small bowel disease.Gastrointest Endosc. 2005; 62: 62-70Abstract Full Text Full Text PDF PubMed Scopus (382) Google Scholar, 25Lenz P. Domagk D. Double- vs. single-balloon vs. spiral enteroscopy.Best Pract Res Clin Gastroenterol. 2012; 26: 303-313Abstract Full Text Full Text PDF PubMed Scopus (56) Google Scholar, 26Elena R.M. Riccardo U. Rossella C. et al.Current status of device-assisted enteroscopy: Technical matters, indication, limits and complications.World J Gastrointest Endosc. 2012; 4: 453-461Crossref PubMed Google Scholar The antegrade route typically is used for lesions located within the proximal two-thirds of the small bowel, whereas the retrograde route is used for lesions in the distal one third, based on capsule endoscopy transit times.27Gay G. Delvaux M. Fassler I. Outcome of capsule endoscopy in determining indication and route for push-and-pull enteroscopy.Endoscopy. 2006; 38: 49-58Crossref PubMed Scopus (231) Google Scholar Interventions that may be performed during DBE include biopsies, mucosal injection, polypectomy, stricture dilation, hemostatic techniques (argon-plasma coagulation, electrocoagulation, and hemoclips), and retrieval of foreign bodies, including retained capsules.28Di Caro S. May A. Heine D.G. et al.The European experience with double-balloon enteroscopy: indications, methodology, safety, and clinical impact.Gastrointest Endosc. 2005; 62: 545-550Abstract Full Text Full Text PDF PubMed Scopus (238) Google Scholar, 29Flynn A.D. Chiorean M.V. Retrieval of a large foreign body from the ileum with double-balloon enteroscopy (with videos).Gastrointest Endosc. 2014; 79: 519-520Abstract Full Text Full Text PDF PubMed Scopus (2) Google ScholarTable 2Technical specifications of enteroscopesEndoscope make/model (manufacturer)TypeLength, mmOuter diameter, mmInner channel, mmField of viewOvertube requiredEN-450T5 (Fujinon)DBE scope23009.42.8140°YesEN-450T5/W (Fujinon)DBE scope23009.42.8140°YesEN-450P5/20 (Fujinon)DBE scope23008.52.2120°YesEC-450BI5 (Fujinon)DBE scope18209.42.8140°YesSIF-Q180 (Olympus)SBE scope20009.22.8140°YesVSB-3430K (Pentax)PE220011.63.8140°NoDBE, Double-balloon enteroscopy; PE, push enteroscopy; SBE, single-balloon enteroscopy. Open table in a new tab DBE, Double-balloon enteroscopy; PE, push enteroscopy; SBE, single-balloon enteroscopy. Total enteroscopy is defined as intubation of the entire small bowel by one or both routes. This approach is useful in patients with multiple small-bowel lesions, negative initial DBE, or high clinical suspicion for small-bowel pathology (ie, OGIB) after a nondiagnostic capsule endoscopy. The total enteroscopy rate for DBE ranges from 0% to 86% and is reportedly highest in the Asian population.5Ell C. May A. Mid-gastrointestinal bleeding: capsule endoscopy and push-and-pull enteroscopy give rise to a new medical term.Endoscopy. 2006; 38: 73-75Crossref PubMed Scopus (112) Google Scholar, 9Khashab M. Helper D.J. Johnson C.S. et al.Predictors of depth of maximal insertion at double-balloon enteroscopy.Dig Dis Sci. 2010; 55: 1391-1395Crossref PubMed Scopus (16) Google Scholar One systematic review of 66 published articles involving 12,823 DBE procedures reported an overall diagnostic yield of 68.1%, with vascular lesions (66%) as the most common finding. The pooled total enteroscopy rate was 44% by the combined (anterograde and retrograde) or antegrade-only approach. Pooled minor and major adverse event (eg, perforation, bleeding, pancreatitis, aspiration pneumonia) rates were 9.1% and 0.72%, respectively.30Xin L. Liao Z. Jiang Y.P. et al.Indications, detectability, positive findings, total enteroscopy, and complications of diagnostic double-balloon endoscopy: a systematic review of data over the first decade of use.Gastrointest Endosc. 2011; 74: 563-570Abstract Full Text Full Text PDF PubMed Scopus (188) Google Scholar Most of the data on adverse events from DE are for DBE, including the German DBE registry, with approximately 4000 DBE procedures, a U.S. data collection of about 2500 DBE procedures, and a European data collection of just under 2400 DBE procedures.31Gerson L.B. Batenic M.A. Newsom S.L. et al.Long-term outcomes after double-balloon enteroscopy for obscure gastrointestinal bleeding.Clin Gastroenterol Hepatol. 2009; 7: 664-669Abstract Full Text Full Text PDF PubMed Scopus (110) Google Scholar, 32Moschler O. May A.D. Muller M.K. et al.Complications in double-balloon-enteroscopy: results of the German DBE register.Z Gastroenterol. 2008; 46: 266-270Crossref PubMed Scopus (85) Google Scholar, 33Mensink P.B. Haringsma J. Kucharzik T. et al.Complications of double balloon enteroscopy: a multicenter survey.Endoscopy. 2007; 39: 613-615Crossref PubMed Scopus (333) Google Scholar Based on these studies, the overall adverse event rate of DBE is approximately 1%. The most severe adverse event in diagnostic DBE is pancreatitis, which is reported in up to 0.3% of antegrade DBE procedures. The risk of severe adverse events is higher in therapeutic DBE and occurs in 3% to 4%.32Moschler O. May A.D. Muller M.K. et al.Complications in double-balloon-enteroscopy: results of the German DBE register.Z Gastroenterol. 2008; 46: 266-270Crossref PubMed Scopus (85) Google Scholar, 33Mensink P.B. Haringsma J. Kucharzik T. et al.Complications of double balloon enteroscopy: a multicenter survey.Endoscopy. 2007; 39: 613-615Crossref PubMed Scopus (333) Google Scholar, 34May A. Nachbar L. Pohl J. et al.Endoscopic interventions in the small bowel using double balloon enteroscopy: feasibility and limitations.Am J Gastroenterol. 2007; 102: 527-535Crossref PubMed Scopus (225) Google Scholar Mortality related to DBE is rare and is reportedly 0.05%.32Moschler O. May A.D. Muller M.K. et al.Complications in double-balloon-enteroscopy: results of the German DBE register.Z Gastroenterol. 2008; 46: 266-270Crossref PubMed Scopus (85) Google Scholar The single-balloon enteroscope (Olympus, Tokyo, Japan) was introduced in 2007. In contrast to the DBE, this device has only 1 balloon (made of silicone)21Pasha S.F. Leighton J.A. Endoscopic techniques for small bowel imaging.Radiol Clin North Am. 2013; 51: 177-187Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar at the distal end of the overtube (Table 2). Single-balloon enteroscopy also is performed by the push-and-pull technique.17DiSario J.A. Petersen B.T. Tierney W.M. et al.ASGE Technology CommitteeEnteroscopes.Gastrointest Endosc. 2007; 66: 872-880Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar The depth of intubation with SBE ranges from 133 cm to 256 cm past the ligament of Treitz with the antegrade approach and from 73 cm to 163 cm past the ileocecal valve with the retrograde approach.12Ramchandani M. Reddy D.N. Gupta R. et al.Diagnostic yield and therapeutic impact of single-balloon enteroscopy: series of 106 cases.J Gastroenterol Hepatol. 2009; 24: 1631-1638Crossref PubMed Scopus (106) Google Scholar, 35Khashab M.A. Lennon A.M. Dunbar K.B. et al.A comparative evaluation of single-balloon enteroscopy and spiral enteroscopy for patients with mid-gut disorders.Gastrointest Endosc. 2010; 72: 766-772Abstract Full Text Full Text PDF PubMed Scopus (98) Google Scholar, 36Upchurch B.R. Sanaka M.R. Lopez A.R. et al.The clinical utility of single-balloon enteroscopy: a single-center experience of 172 procedures.Gastrointest Endosc. 2010; 71: 1218-1223Abstract Full Text Full Text PDF PubMed Scopus (71) Google Scholar The rate of total enteroscopy has been reported between 15% and 25%.10Tsujikawa T. Saitoh Y. Andoh A. et al.Novel single-balloon enteroscopy for diagnosis and treatment of the small intestine: preliminary experiences.Endoscopy. 2008; 40: 11-15Crossref PubMed Scopus (291) Google Scholar, 12Ramchandani M. Reddy D.N. Gupta R. et al.Diagnostic yield and therapeutic impact of single-balloon enteroscopy: series of 106 cases.J Gastroenterol Hepatol. 2009; 24: 1631-1638Crossref PubMed Scopus (106) Google Scholar The diagnostic yield of SBE ranges from 47% to 60%, and the range of possible endoscopic therapeutics offered are similar to those of DBE.12Ramchandani M. Reddy D.N. Gupta R. et al.Diagnostic yield and therapeutic impact of single-balloon enteroscopy: series of 106 cases.J Gastroenterol Hepatol. 2009; 24: 1631-1638Crossref PubMed Scopus (106) Google Scholar, 36Upchurch B.R. Sanaka M.R. Lopez A.R. et al.The clinical utility of single-balloon enteroscopy: a single-center experience of 172 procedures.Gastrointest Endosc. 2010; 71: 1218-1223Abstract Full Text Full Text PDF PubMed Scopus (71) Google Scholar The overall adverse event rate from diagnostic SBE is approximately 1%,37May A. Modern imaging techniques: which—when—why?.Dig Dis. 2013; 31: 63-68Crossref PubMed Scopus (2) Google Scholar which is equivalent to that of diagnostic DBE. The risk of deep mucosal tears or perforation of a diagnostic SBE examination might be higher if the endoscope tip is flexed during advancement of the overtube, which may occur in the presence of adhesions related to prior abdominal surgery or anastomotic strictures.10Tsujikawa T. Saitoh Y. Andoh A. et al.Novel single-balloon enteroscopy for diagnosis and treatment of the small intestine: preliminary experiences.Endoscopy. 2008; 40: 11-15Crossref PubMed Scopus (291) Google Scholar, 11Kawamura T. Yasuda K. Tanaka K. et al.Clinical evaluation of a newly developed single-balloon enteroscope.Gastrointest Endosc. 2008; 68: 1112-1116Abstract Full Text Full Text PDF PubMed Scopus (137) Google Scholar, 12Ramchandani M. Reddy D.N. Gupta R. et al.Diagnostic yield and therapeutic impact of single-balloon enteroscopy: series of 106 cases.J Gastroenterol Hepatol. 2009; 24: 1631-1638Crossref PubMed Scopus (106) Google Scholar, 38Tominaga K. Iida T. Nakamura Y. et al.Small intestinal perforation of endoscopically unrecognized lesions during peroral single-balloon enteroscopy.Endoscopy. 2008; 40: E213-E214Crossref PubMed Scopus (14) Google Scholar The technique of “power suction”39Kav T. Balaban Y. Bayraktar Y. The power suction maneuver in single-balloon enteroscopy.Endoscopy. 2008; 40 (author reply 962): 961-962Crossref PubMed Scopus (15) Google Scholar (continuous suction) might help to reduce the injuries caused by the inverted endoscope tip technique. The Endo-Ease Discovery SB (Spirus Medical, Stoughton, Mass) is a spiral overtube made of polyvinyl chloride (Table 3) that navigates the small bowel by using a rotational endoscopy technique. With the exception of 1 pilot study of 6 patients by using retrograde SE,40Lara L.F. Singh S. Sreenarasimhaiah J. Initial experience with retrograde overtube-assisted enteroscopy using a spiral tip overtube.Proc (Bayl Univ Med Cent). 2010; 23: 130-133PubMed Google Scholar all studies have described SE by using the antegrade approach. The mean depth of intubation with SE ranges from 176 cm to 250 cm.14Akerman P.A. Agrawal D. Chen W. et al.Spiral enteroscopy: a novel method of enteroscopy by using the Endo-Ease Discovery SB overtube and a pediatric colonoscope.Gastrointest Endosc. 2009; 69: 327-332Abstract Full Text Full Text PDF PubMed Scopus (98) Google Scholar, 35Khashab M.A. Lennon A.M. Dunbar K.B. et al.A comparative evaluation of single-balloon enteroscopy and spiral enteroscopy for patients with mid-gut disorders.Gastrointest Endosc. 2010; 72: 766-772Abstract Full Text Full Text PDF PubMed Scopus (98) Google Scholar, 41Morgan D. Upchurch B. Draganov P. et al.Spiral enteroscopy: prospective U.S. multicenter study in patients with small-bowel disorders.Gastrointest Endosc. 2010; 72: 992-998Abstract Full Text Full Text PDF PubMed Scopus (74) Google Scholar The main advantage of SE is the relative reduction of procedure time. However, a major limitation is the very low rate of complete enteroscopies, mainly caused by difficult retrograde passage.42Messer I. May A. Manner H. et al.Prospective, randomized, single-center trial comparing double-balloon enteroscopy and spiral enteroscopy in patients with suspected small-bowel disorders.Gastrointest Endosc. 2013; 77: 241-249Abstract Full Text Full Text PDF PubMed Scopus (67) Google Scholar Adverse events with SE include minor mucosal tears, and perforation has been reported in 0.3% of patients.43Akerman P.A. Haniff M. Spiral enteroscopy: prime time or for the happy few?.Best Pract Res Clin Gastroenterol. 2012; 26: 293-301Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar, 44Akerman P.A. Cantero D. Spiral enteroscopy and push enteroscopy.Gastrointest Endosc Clin N Am. 2009; 19: 357-369Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar, 45Judah J.R. Draganov P.V. Lam Y. et al.Spiral enteroscopy is safe and effective for an elderly United States population of patients with numerous comorbidities.Clin Gastroenterol Hepatol. 2010; 8: 572-576Abstract Full Text Full Text PDF PubMed Scopus (37) Google ScholarTable 3Technical specifications of enteroscope overtubesOvertube make/modelTypeLength, mmOuter diameter, mmInner diameter, mmBalloon diameter or spiral height, mmScope compatibilityFujinon TS-12140DBE overtube145012.21040EN-450P5/20 TS-13140DBE overtube145013.210.840EN-450T5, EN-450T5/W TS-13101DBE overtube105013.210.840EC-450BI5Olympus ST-SB1SBE overtube132013.21140SIF-Q180Spirus Medical Endo-Ease Discovery, standard profileSpiral enteroscopy118014.59.85.5SIF-Q180EN-450T5EN-450T5/WEN-450P5/20EC-450BI5 Endo-Ease Discovery, low profileSpiral enteroscopy118014.59.84.5SIF-Q180EN-450T5EN-450T5/WEN-450P5/20EC-450BI5 Endo-Ease Vista, retrogradeSpiral enteroscopy100017.4135Pediatric colonoscopeDBE, Double-balloon enteroscopy; SBE, single-balloon enteroscopy. Open table in a new tab DBE, Double-balloon enteroscopy; SBE, single-balloon enteroscopy. Multiple retrospective and prospective trials have compared the diagnostic yield, depth of maximal insertion allowed, efficacy, and adverse events of the 3 DE techniques. Four prospective randomized studies have compared technical aspects and therapeutic outcomes between DBE and SBE.46May A. Farber M. Aschmoneit I. et al.Prospective multicenter trial comparing push-and-pull enteroscopy with the single- and double-balloon techniques in patients with small-bowel disorders.Am J Gastroenterol. 2010; 105: 575-581Crossref PubMed Scopus (187) Google Scholar, 47Takano N. Yamada A. Watabe H. et al.Single-balloon versus double-balloon endoscopy for achieving total enteroscopy: a randomized, controlled trial.Gastrointest Endosc. 2011; 73: 734-739Abstract Full Text Full Text PDF PubMed Scopus (134) Google Scholar, 48Domagk D. Mensink P. Aktas H. et al.Single- vs. double-balloon enteroscopy in small-bowel diagnostics: a randomized multicenter trial.Endoscopy. 2011; 43: 472-476Crossref PubMed Scopus (137) Google Scholar, 49Efthymiou M. Desmond P.V. Brown G. et al.SINGLE-01: a randomized, controlled trial comparing the efficacy and depth of insertion of single- and double-balloon enteroscopy by using a novel method to determine insertion depth.Gastrointest Endosc. 2012; 76: 972-980Abstract Full Text Full Text PDF PubMed Scopus (53) Google Scholar One prospective multicenter trial comparing the DBE and SBE techniques in 100 patients showed that the DBE technique yielded a higher rate of total enteroscopy and therapeutic yield compared with the SBE technique.46May A. Farber M. Aschmoneit I. et al.Prospective multicenter trial comparing push-and-pull enteroscopy with the single- and double-balloon techniques in patients with small-bowel disorders.Am J Gastroenterol. 2010; 105: 575-581Crossref PubMed Scopus (187) Google Scholar The rate of complete enteroscopy was 3 times higher in the DBE group compared with the SBE group (66% vs 22%; P < .0001). Therapeutic yield, defined as findings requiring treatment, was significantly higher in the DBE group (72% vs 48%; P = .025). These results are similar to those reported by a prospective single-center Japanese trial comparing DBE with SBE, which demonstrated a complete enteroscopy rate for DBE of 57% compared with 0% for SBE (P = .002).47Takano N. Yamada A. Watabe H. et al.Single-balloon versus double-balloon endoscopy for achieving total enteroscopy: a randomized, controlled trial.Gastrointest Endosc. 2011; 73: 734-739Abstract Full Text Full Text PDF PubMed Scopus (134) Google Scholar In contrast, the third multicenter comparative trial found no differences between the 2 systems, but the rate of complete enteroscopy was lower than expected in the DBE group (18%).48Domagk D. Mensink P. Aktas H. et al.Single- vs. double-balloon enteroscopy in small-bowel diagnostics: a randomized multicenter trial.Endoscopy. 2011; 43: 472-476Crossref PubMed Scopus (137) Google Scholar The fourth study, from Australia, compared both techniques in a randomized trial of 116 patients and reported similar diagnostic and th" @default.
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• W1694166411 date "2015-10-01" @default.
• W1694166411 modified "2023-10-01" @default.
• W1694166411 title "The role of deep enteroscopy in the management of small-bowel disorders" @default.
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