Multicenter Comparison of Double-Balloon Enteroscopy and Spiral Enteroscopy

Gabriel Rahmi; Elia Samaha; Kouroche Vahedi; Thierry Ponchon; Fabien Fumex; Bernard Filoche; Gerard Gay; Michel Delvaux; Camille Lorenceau-Savale; Georgia Malamut; Jean-Marc Canard; Gilles Chatellier; Christophe Cellier


J Gastroenterol Hepatol. 2013;28(6):992-998. 

In This Article

Abstract and Introduction


Background and Aim: Spiral enteroscopy is a novel technique for small bowel exploration. The aim of this study is to compare double-balloon and spiral enteroscopy in patients with suspected small bowel lesions.

Methods: Patients with suspected small bowel lesion diagnosed by capsule endoscopy were prospectively included between September 2009 and December 2010 in five tertiary-care academic medical centers.

Results: After capsule endoscopy, 191 double-balloon enteroscopy and 50 spiral enteroscopies were performed. Indications were obscure gastrointestinal bleeding in 194 (80%) of cases. Lesions detected by capsule endoscopy were mainly angioectasia. Double-balloon and spiral enteroscopy resulted in finding one or more lesions in 70% and 75% of cases, respectively. The mean diagnosis procedure time and the average small bowel explored length during double-balloon and spiral enteroscopy were, respectively, 60 min (45–80) and 55 min (45–80) (P = 0.74), and 200 cm (150–300) and 220 cm (200–300) (P = 0.13). Treatment during double-balloon and spiral enteroscopy was possible in 66% and 70% of cases, respectively. There was no significant major procedure-related complication.

Conclusion: Spiral enteroscopy appears as safe as double-balloon enteroscopy for small bowel exploration with a similar diagnostic and therapeutic yield. Comparison between the two procedures in terms of duration and length of small bowel explored is slightly in favor of spiral enteroscopy but not significantly.


Small bowel endoscopic evaluation improved significantly with video capsule endoscopy (CE). However, limitations of this procedure include the inability to obtain biopsy specimens, to navigate in altered anatomy, and to perform therapeutic maneuvers.[1,2] Push enteroscopy also has limitations because of gastric looping, which limits the ability to transmit axial force onto the endoscope.[3,4] Device-assisted enteroscopy techniques, including the double-balloon enteroscopy (DBE), single-balloon enteroscopy (SBE), and spiral enteroscopy (SE), have both diagnostic and therapeutic capabilities. The DBE, first introduced by Yamamoto in 2001, is an overtube-assisted antegrade or retrograde endoscopy allowing deep small bowel exploration with a good diagnostic and therapeutic yield.[5–12]

It is considered as the most studied and validated deep enteroscopy technique. Data about SBE are more limited, but good small bowel exploration has also been reported.[13,14] The SE (Spirus Medical, Inc., Stoughton, MA, USA) is a newer per-oral technique that relies on pleating the small bowel by clockwise rotation of an overtube with a raised helix tip. Preliminary studies have shown that potential advantages of this technique include rapid small bowel examination, stability within the small bowel, and controlled examination of intestinal mucosa.[15–17] The primary aim of this multicenter study was to compare SE and DBE in terms of diagnostic and therapeutic yields, depth of insertion, and procedure duration. Moreover, we conducted a systematic review of the literature about SE.