Lipka Seth, Rabbanifard Roshanak, Kumar Ambuj, Brady Patrick
*Division of Digestive Diseases and Nutrition, University of South Florida Morsani College of Medicine †Department of Medicine, Division of Evidence Based Medicine and Outcomes Research, University of South Florida Morsani College of Medicine, Tampa, FL.
J Clin Gastroenterol. 2015 Mar;49(3):177-84. doi: 10.1097/MCG.0000000000000274.
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.
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.
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).
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.
双气囊小肠镜检查（DBE）和单气囊小肠镜检查（SBE）是两种常用的气囊辅助小肠镜技术，用于“深度小肠镜检查”。尽管有多项随机对照试验评估了DBE与SBE相比的优势，但各随机对照试验的结果似乎相互矛盾。我们进行了一项系统评价和荟萃分析，以评估DBE与SBE相比的疗效。
主要结局为诊断和治疗成功率。次要结局为失败率、不良事件、全小肠镜检查、顺行/逆行插入深度和操作时间。我们检索了MEDLINE和Cochrane对照试验中心注册库（CENTRAL），检索时间从建库至2014年2月28日，以及其他数据库。为确保整个系统评价过程的质量，进行了双人提取。系统评价按照Cochrane协作网的标准进行。
纳入了4项试验，共375例患者。DBE在治疗成功率[风险比（RR），1.11；95%置信区间（CI）：0.90，1.37；P = 0.33]、诊断成功率（RR = 1.08；95% CI：0.89，1.32；P = 0.42）、失败率（RR = 0.68；95% CI：0.23，2.05；P = 0.5）、总体不良事件（RR = 1.41；95% CI：0.32，6.3；P = 0.65）或全小肠镜检查率（RR = 1.73；95% CI：0.86，3.48；P = 0.12）方面并不优于SBE。没有证据表明这两种方式在顺行或逆行操作时间上存在优势[平均差（MD），3.78；95% CI，-30.76，38.32；P = 0.83；以及MD，-0.53；95% CI：-7.66，6.59；P = 0.88]。在分析的两项研究中，顺行和逆行插入深度似乎均无差异（MD，-7.36；95% CI：-40.36，25.64；P =
