Single Versus Double Balloon Enteroscopy for Small Bowel Diagnostics A Systematic Review and Meta-analysis

Introduction: Double balloon enteroscopy (DBE) and single balloon enteroscopy (SBE) are 2 types of commonly used balloon-assisted enteroscopic techniques for "deep enteroscopy." Although there are several randomized controlled trials assessing the superiority of DBE compared with SBE, the results from individual randomized controlled trials seem conflicting. We performed a systematic review and meta-analysis to assess the efficacy of DBE compared with SBE. Methods: Primary outcomes were diagnostic and therapeutic yield. Secondary outcomes were failure rates, adverse events, complete enteroscopy, anterograde/retrograde insertion depths, and procedure times. We searched MEDLINE and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception until February 28, 2014, as well as other databases. For quality assurance purposes throughout the systematic review process, dual extraction was performed. The systematic review was performed as per the standards of Cochrane collaboration. Results: Four trials enrolling a total of 375 patients were included. DBE did not offer an advantage over SBE in therapeutic yield [risk ratio (RR), 1.11; 95% confidence interval (CI): 0.90, 1.37; P = 0.33)] or diagnostic yield (RR = 1.08; 95% CI: 0.89, 1.32; P = 0.42), failure rates (RR = 0.68; 95% CI: 0.23, 2.05; P = 0.5), overall adverse events (RR = 1.41; 95% CI: 0.32, 6.3; P = 0.65), or complete enteroscopy rates (RR = 1.73; 95% CI: 0.86, 3.48; P = 0.12). No evidence existed for an advantage of anterograde or retrograde procedure time between these 2 modalities [mean difference (MD), 3.78; 95% CI, -30.76, 38.32; P = 0.83; and MD, -0.53; 95% CI: -7.66, 6.59; P = 0.88, respectively]. Neither anterograde nor retrograde insertion depths appeared to differ between the 2 studies analyzed (MD, -7.36; 95% CI: -40.36, 25.64; P = 0.66 and MD, 7.86; 95% CI: -12.68, 28.40; P = 0.45, respectively). Conclusions: Performance of SBE and DBE appears to be similar in terms of diagnostic/therapeutic yield, insertion depths, procedure time, complete enteroscopy, failure rates, or adverse events.