Abstract
BACKGROUND: Balloon-assisted enteroscopy (BAE) (both single- and double-balloon enteroscopy) has garnered attention in the treatment of small intestine strictures in patients with Crohn's disease (CD). This study aimed to evaluate the pooled clinical outcomes of BAE-mediated endoscopic dilation of small intestine strictures in patients with CD. METHODS: We searched multiple databases for articles reporting outcomes following BAE for small intestinal strictures in patients with CD. Outcomes studied were pooled technical success, clinical success and adverse events. Standard meta-analysis methods were employed using the random-effects model, and heterogeneity was studied using I (2) statistics. RESULTS: We analyzed 26 studies, 9 prospective and 17 retrospective, involving 1570 patients. The pooled technical success rate of double-balloon enteroscopy was 87.6% (95% confidence interval [CI] 82.1-91.5; I (2)=53%) and the pooled therapeutic success rate was 69.7% (95%CI 61.6-76.7; I (2)=71%). The pooled major complications per procedure were 5.5% (95%CI 3.5-8.4; I (2)=57%); the risk of bleeding was 2.5% (95%CI 1.4-4.2; I (2)=28%), and the risk of perforation was 2.7% (95%CI 1.6-4.5; I (2)=3%). The pooled rate of recurrence after the first dilation was 42.3% (95%CI 16.9-72.5; I (2)=59%), and the rate of repeat endoscopic balloon dilation was 23.9% (95%CI 14.1%-37.5%; I (2)=85%), while the pooled rate of repeat surgery was 25.3% (95%CI 11.8%-46.0%; I (2)=44%]. CONCLUSION: BAE is a good first line approach for patients with CD-induced strictures in an attempt to treat symptoms and potentially avoid surgery.