title: Single versus double balloon enteroscopy for small bowel diagnostics: a systematic review and meta-analysis.
abstract: BACKGROUND
  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.
authors.affiliation: *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.
authors.forename: Seth
authors.initials: S
authors.lastname: Lipka
authors.forename: Roshanak
authors.initials: R
authors.lastname: Rabbanifard
authors.forename: Ambuj
authors.initials: A
authors.lastname: Kumar
authors.forename: Patrick
authors.initials: P
authors.lastname: Brady
mesh_terms: D016009:Chi-Square Distribution; D058582:Double-Balloon Enteroscopy / Q000009:adverse effects; D006801:Humans; D007410:Intestinal Diseases / Q000473:pathology*; D007421:Intestine, Small / Q000473:pathology*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors