10 years - Over 1000 cases - Summary and analysis of enteroscopy, a single-center retrospective study

10 years - Over 1000 cases - Summary and analysis of enteroscopy, a single-center retrospective study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article 10 years - Over 1000 cases - Summary and analysis of enteroscopy, a single-center retrospective study Jiaqin Xu, Qiaomin Wang, Li Xie, Xuemei Xu, Xiuli Zhu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7584481/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: The diagnosis of small bowel diseases remains challenging due to limited available diagnostic modalities. This study retrospectively analyzed clinical data from over 1,000 enteroscopy procedures performed over a period of more than 10 years to evaluate the diagnostic value of enteroscopy. Methods: This was a single-center, retrospective observational study. Patient demographic and clinical data were collected, including gender, age, examination date, anesthesia method, transoral or transanorectal approach, endoscopic insertion depth, examination findings, complications, and concordance with diagnoses obtained via small bowel CT or capsule endoscopy. Statistical analysis was performed using SPSS software. Results: A total of 1,215 patients were included in the study, of whom 297 underwent double-balloon enteroscopy (DBE) and 918 underwent single-balloon enteroscopy (SBE). Among them, 210 underwent oral enteroscopy, 814 underwent anal enteroscopy, and 191 underwent combined oral and anal enteroscopy. The indications for enteroscopy varied, with the most common being abdominal pain (41.1%) and routine follow-up for Crohn's disease (CD) (21.9%). Endoscopic evaluation revealed 555 cases (45.7%) of CD or suspected CD, 210 cases (17.3%) of non-CD small bowel ulcers and erosions (including intestinal tuberculosis, Behcet's disease, nonspecific inflammation, or undiagnosed conditions), 162 cases (13.3%) with negative findings (normal results or findings not explaining the patient's symptoms), 77 cases (6.3%) of small bowel tumors, and 68 cases (5.6%) of small bowel vascular malformations. Three patients experienced gastrointestinal perforation either during the procedure or within 24 hours post-examination. Conclusions: Enteroscopy demonstrates significant diagnostic utility for conditions such as unexplained abdominal pain, gastrointestinal bleeding, celiac disease, and small intestinal tumors. Overall, the procedure is considered safe. DBE achieves greater insertion depth compared to SBE, and the oral approach allows for deeper intubation than the anal route. Patients under general anesthesia generally exhibit good tolerance. Small bowel diseases single balloon enteroscopy double balloon enteroscopy enteroscopy Figures Figure 1 Figure 2 Introduction The small intestine accounts for about 75% of the gastrointestinal tract, and its mucosa accounts for about 90% of the surface area of the intestinal cavity. The small intestine, long and curved, was the blind area of digestive endoscopy for a long time, until the advent of video capsule endoscopy and balloon endoscopy, a breakthrough in the field of small intestine examination[1]. Capsule endoscopy is a safe method, and in most cases the entire small intestine can be seen under the endoscope, but a major disadvantage of this method is the inability to obtain a histological sample and perform endoscopic treatment[2]. Due to the unique anatomical characteristics of the small intestine, capsule endoscopy has certain blind areas, and there is a relative contraindication in patients with stenosis and obstruction. Enteroscopy makes up for this lack, allowing intuitive exploration without dead corners, biopsy and treatment. Of course, it is an invasive operation with risks such as bleeding, perforation and infection. Enteroscopy includes single balloon enteroscopy (SBE) and double balloon enteroscopy (DBE). DBE system consists of a high-resolution video endoscope with a working length of 200cm and consists of a flexible upper tube made of polyurethane. The latex balloon is attached to the tip and upper tube of the enteroscopy and can be filled with air or emptied with a pressure-controlled pump. The principle of DBE technology is based on alternating propulsion and traction operations that allow the small intestine to be attached to the outer cannula step by step[3]. In 2008, Olympus introduced a new, simplified SBE that uses one balloon instead of two to facilitate access to the small intestine. In theory, the use of this SBE system may reduce preparation and examination time. However, SBE may be less efficient than DBE for deep intubation of the small intestine and may cause adverse reactions due to the use of the hook technique during single balloon endoscopic straightening[4-5]. Small bowel diseases(SBDs) including obscure gastrointestinal bleeding (OGIB), unexplained abdominal pain, chronic diarrhea, various small bowel ulcers including infection, tumor, inflammatory bowel disease, Crohn's disease(CD), celiac disease, familial polyposis, and so on, can be diagnosed and treated by endoscopy[6-7]. Non-surgical treatment of SBDs is difficult. This is due to the lack of appropriate research models to venture into long redundant small intestine circulation. Balloon enteroscopy performs aspiration and irrigation through instrumental channels, sampling biopsy, and therapeutic interventions such as argon plasma coagulation (APC) , submucosal injection, clip location, polyp resection, dilation, and foreign body removal. To date, an increasing number of global studies have reported on the diagnostic and therapeutic value of DBE and SBE in managing small intestinal diseases. However, most of these studies are limited by small sample sizes or are multicenter in nature, with the majority of clinical experience originating from Japan and Europe. Data regarding the application and outcomes of balloon enteroscopy in China remain limited. Based on over a decade of clinical data from more than 1,000 enteroscopy cases, our study primarily analyzed the indications for enteroscopy, lesion detection rates, and its comparative advantages relative to small bowel CT and capsule endoscopy. The objective of this research is to evaluate the diagnostic efficacy of enteroscopy in small intestinal diseases and provide clinically relevant insights for routine practice. Methods Study Design and Patient Population This study is a single-center, retrospective observational study spanning a 10-year period. Inclusion criteria: All patients who underwent balloon-assisted enteroscopy at our institution between January 2015 and July 2025 were included. Exclusion criterion: (1) Due to the long duration of the study period, multiple hospital information system upgrades occurred, resulting in incomplete or missing enteroscopy records. Patients with such incomplete data were excluded from the analysis. (2) Patients for whom the insertion depth during transoral or transanal enteroscopy was not documented were also excluded. This study has been approved by the Medical Ethics Committee of the First Affiliated Hospital of University of Science and Technology of China. Perioperative preparation for enteroscopy (1) The patient did not drink or eat after 10 p.m. the previous night, and received an oral enteroscopy on an empty stomach the next day. Transanal enteroscopy requires bowel cleaning the day before. (2) The initial insertion route of the enteroscopy (anal or oral) is selected based on clinical presentation and imaging findings, if any, based on the estimated location of the suspected lesion. Lesions expected to be located in the upper two-thirds of the small intestine are examined orally first, while other lesions begin with anal examination and are examined both orally and transanal if necessary. The examination continued until the target lesion was reached, or until no further progress was deemed possible. (3) The whole procedure was performed through the cooperation of two doctors and one nurse. (4) Patients can receive intravenous general anesthesia or tracheal intubation anesthesia, usually poor cardiopulmonary function, transoral enteroscopy requires tracheal intubation anesthesia. During DBE/SBE, oxygen was inhaled with electrocardiographic monitoring. Data Collection Collect the basic and clinical data of the patients, including gender, age, examination date, anesthesia method, transoral or transanal enteroscopy, endoscopic insertion depth, examination results, complications, and consistency with the diagnosis of small bowel CT or capsule endoscopy. Statistical analysis Quantitative variables were represented as mean ± SD or as median with interquartile range and compared using Student's t-test or nonparametric tests. The categorical variables were expressed in counts (percentages) and analyzed using the chi-square test or Fisher's exact test. A p-value less than 0.05 (double tailed) was considered significant. All statistical analyses were performed in SPSS version 25.0. Results 1. The basic information Ultimately, 1,215 patients were enrolled in the study. The mean age was 41.67±15.75 year. There were 801 male patients and 414 female patients. Among them, 899 (74.0%) patients received general anesthesia, while 316 (26.0%) patients received non-general anesthesia. 297 (24.4%) patients underwent DBE, and 918 (75.6%) patients underwent SBE. A total of 357 cases occurred before 2020 (inclusive), and 858 cases occurred after 2020. 210 (17.3%) patients underwent oral enteroscopy, 814 (67.0%) patients underwent anal enteroscopy, and 191 (15.7%) patients underwent combined oral and anal enteroscopy. A total of 27 cases of full small bowel examination were completed. The mean oral insertion depth was 2.02±0.98 meters, and the anal insertion depth was 1.16±1.65 meters. Regarding the insertion depth of endoscopy, for SBE, the insertion depth is 1.99+0.94 meters through the oral and 1.17+1.86 meters through the anal. For DBE, the insertion depth is 2.08+1.08 through the oral and 1.12+0.66 through the anal. The insertion depth through the oral is greater than that through the anal, and the insertion depth of the DBE is greater than that of the SBE. The reasons for patients to undergo enteroscopy varied. These mainly included abdominal pain (41.1%), regular follow-up for CD (21.9%), gastrointestinal bleeding, diarrhea, and others (such as abdominal distension, vomiting, anemia, and fever). The general information of the patients is presented in Table 1 . 2. The inspection situation of each year From July 2015 to July 2025, the total volume of enteroscopy examinations at our center has been increasing year by year. Among them, the growth rate was relatively high in 2019 and 2021. The total volume decreased in several years due to the COVID-19 pandemic and the suspension of endoscopy maintenance. There was only one failed case of enteroscopy in our center. The patient was suspected of having CD and the enteroscopy was performed through the anus to the sigmoid colon without general anesthesia. The pain was unbearable and the patient could not tolerate it, so the examination was terminated. Since 2018, our center has attempted to perform enteroscopy under general anesthesia. The patient's tolerance has improved, and the overall examination volume has increased. All enteroscopy procedures have been successfully completed. The volume of SBE is significantly higher than that of DBE, which may be related to the fact that the number of patients in the central campus (where SBE is carried out) of this center is larger than that in the South campus (where DBE is carried out). For detailed information, please refer to Figure 1 . 3. Analysis of colonoscopy results Ultimately, through enteroscopy, 555 (45.7%) cases of CD or suspected CD, 210 (17.3%) cases of non-CD small bowel ulcers and erosions (bowel tuberculosis, Behcet's disease, nonspecific inflammation or undiagnosed), 162 (13.3%) cases of negative results (The result is normal or cannot explain the cause of the patient's illness), 77 (6.3%) cases of small bowel tumors, 68 (5.6%) cases of small bowel vascular malformations, and 143 (11.8%) other cases were diagnosed including diverticula, foreign bodies, villous atrophy, allergic purpura, and so on . See Table 2 for details. A total of 867 patients underwent enhanced CT examinations of the small bowel. Among these patients, the CT diagnoses of 707 cases were largely consistent with those obtained through enteroscopy. The diagnostic consistency between CT and enteroscopy was relatively high for small bowel space-occupying lesions and CD. In 160 cases, the diagnoses did not match those of enteroscopy, including small bowel vascular diseases, diverticula, and congestion with mucosal erosion. Additionally, a total of 45 patients underwent capsule endoscopy. Of these, 27 cases showed diagnoses consistent with enteroscopy, primarily involving CD and small bowel space-occupying lesions. In 18 cases, the diagnoses were inconsistent with those of enteroscopy, mainly involving small bowel space-occupying lesions and vascular malformations. 4. Safety and complications One patient discontinued the small bowel endoscopy due to severe pain and an inability to tolerate the procedure without general anesthesia. A total of three patients experienced gastrointestinal perforation complications either during the examination or within 24 hours post-examination. Of these, two cases showed improvement following surgical intervention, while the remaining case resolved with conservative management. Among the patients with digestive tract perforation, two cases were of CD stenosis type, one case was a patient with bowel infarction and bowel obstruction, one case underwent oral enteroscopy, and two cases underwent anal enteroscopy, all of which were SBE. No other significant complications, such as gastrointestinal bleeding, infection, or pancreatitis, were observed in the remaining patients. 5. Typical case Figure 2 presents images of several typical small bowel diseases diagnosed at our center. Case A involves a 49-year-old female patient who presented with abdominal pain and was subsequently diagnosed with small bowel adenocarcinoma. Case B is a 54-year-old male who sought medical attention due to gastrointestinal bleeding and was ultimately diagnosed with small bowel vascular malformation. Case C is a 50-year-old male who presented with abdominal pain and diarrhea. Capsule endoscopy revealed multiple ulcers in the small intestine, and the capsule became lodged in the small bowel. The capsule endoscope was later retrieved via enteroscopy, and the patient was diagnosed with small bowel CD. Case D is a 59-year-old female who presented with diarrhea and was ultimately diagnosed with B-cell lymphoma. Case E is a 14-year-old male who visited the hospital due to gastrointestinal bleeding and was finally diagnosed with Meckel diverticulum. Cases F and G are both 38-year-old males who presented with abdominal pain and anemia; both were ultimately diagnosed with cryptogenic multifocal ulcerous stenosing enteritis (CMUSE). Case H is a 22-year-old male who presented with abdominal pain and was ultimately diagnosed with stenostrictive Crohn’s disease. Discussion SBDs lack specific signs and symptoms, and diagnosis and treatment is a difficult task for clinicians. Since the 21st century, capsule endoscopy and enteroscopy have emerged as new endoscopic methods for small intestine exploration, which can directly see the inside of the small intestine. In optimal case, the entire small intestine, or at least a sizable portion, can be examined using a balloon colonoscopy. Depending on the experience level of the endoscopist, total colonoscopy using the double balloon method is about 40% to 80%(up to 86%), and SBE is currently up to 25% before 2008. In recent years, with the improvement of the level of endoscopists, the success rate of whole small intestine examination has also been greatly improved[8,9]. A head-to-head comparison study shows that DBE and SBE have a comparable performance and diagnostic yield for evaluation of the small intestine, accordingly, both techniques seem to be interchangeable in daily small intestine examination[10]. During the DBE, the esophagus, the stomach, and the colon are reexamined, and missed lesions can be located and treated. Previous studies on push enteroscopy and capsule endoscopy have shown that up to 25% of patients with recurrent gastrointestinal bleeding had a bleeding source within the reach of the gastroscope[11,12]. Using data from a standard questionnaire, the German researchers established a prospective database of all DBE examinations at 62 endoscopic centers, including personal information, indications, surgical information, interventions, diagnoses, and complications. Over a 2-year period, 2,245 DBE tests were performed on 1,765 patients. The most common test pointer is small intestine bleeding, and the most frequent intervention was argon plasma coagulation of angiodysplasia. There were 27 complications, and the complication rate for all tests was 1.2%[13]. In a 2007 prospective study evaluating the impact of double balloon colonoscopy on the diagnosis and treatment of patients with suspected or documented small bowel disease, a total of 118 double balloon colonoscopies were performed, with an overall diagnosis rate of 69%, the most common narrowness manifestations include vascular dysplasia, ulcers and erosion of various etiologies, tumors, and small intestine stenosis in patients suspected of Crohn's disease[14]. Our research analyzed and summarized the reasons why patients underwent enteroscopy and found that the reasons varied among these patients, mainly including abdominal pain (41.1%), regular follow-up of celiac disease (21.9%), gastrointestinal bleeding, diarrhea and others (such as abdominal distension, vomiting, anemia and fever). Many patients in our center have undergone enteroscopy due to suspected CD, regular follow-up for CD, or due to complications in CD patients, accounting for 266 (21.9%). CD is a chronic granulomatous inflammatory bowel disease characterized by leaping lesions and transmural inflammation that can involve the entire digestive tract from the oral cavity to the anus. Common complications include gastrointestinal bleeding, perforation, and obstruction caused by stenosis. CD lesions often involve the ileum and colon, but stenosis is more likely to occur in the small intestine than the colon[15]. Therefore, CD patients most often receive surgical treatment for small bowel stenosis. Treatment options for patients with CD stenosis are medication, endoscopic therapy, usually endoscopic balloon dilatation (EBD), and surgery, including stenoplasty[16]. Enteroscopy dilation therapy brings benefits to CD patients, can reduce or delay surgery, greatly reduce trauma. EBD is a minimally invasive procedure with a high success rate and a low rate of surgical complications, however, patients need to undergo repeated procedures to avoid surgery, which ultimately reduces quality of life[17-19]. Three patients with stenotic CD in this center underwent EBD or endoscopic incision surgery under enteroscopy. They recovered well during the operation and had no obvious complications. Our center diagnosed 77 cases (6.3%) of small bowel space-occupying lesions through enteroscopy. Pathology confirmed that stromal tumors and lymphomas were the most common. The incidence of small intestine tumors is not high, accounting for about 2-5% of all digestive systems. However, most small intestine tumors are malignant or have malignant potential, including gastrointestinal stromal tumors (gist), lymphomas, primary adenocarcinomas [1] tumors, and neuroendocrine tumors. They have no clinical symptoms in the early stages and are difficult to pass routine endoscopy due to their deep location. Therefore, early detection of small intestine tumors is extremely difficult[20-23]. A retrospective study found that DBE was a reliable method for diagnosing small bowel tumors, which were predominantly located in the jejunum and were characterized by unexplained gastrointestinal bleeding and abdominal pain[24]. A prospective study found that double-balloon colonoscopy is a viable diagnostic tool for patients with incomplete small bowel obstruction without a history of abdominal surgery, and for patients whose cause is not clear from routine radiography. The most frequent causes of small bowel obstruction are postoperative adhesions and hernias. However, the most common cause in patients without a history of abdominal surgery is small intestine tumors and stenosis[25]. Our research also found that for small bowel space-occupying lesions and CD, the diagnostic consistency between small bowel enhanced CT and enteroscopy is relatively high, but the diagnostic value of small bowel enhanced CT for small bowel vascular malformations, small bowel diverticula, and mucosal erosion is not high. Capsule endoscopy has a relatively high diagnostic value for small bowel vascular malformations. Despite the use of balloons, the location of the deep small intestine is sometimes unstable, and flexibility is limited because the small intestine is screwed onto the outer cannula, in addition, the small intestine wall is very thin. For all these reasons, the complication rate is likely to be higher than that with procedures in the upper and lower gastrointestinal tract. Complications of enteroscopy include gastrointestinal bleeding, perforation, infection, pancreatitis, etc., the incidence is generally very low. The occurrence of complications was related to the operation level of endoscopists, the general condition of patients, the history of abdominal surgery, and the history of hormone and immunosuppressive therapy[26,27]. Balloon enteroscopy appears to be a safe procedure. However, when passing a small bowel lesion or in patients with known adhesions or strictures, careful operation is required. As in conventional endoscopy, the risk is higher in therapeutic enteroscopy[28,29]. A large pilot series shows that DBE is a well tolerated and safe new endoscopic technique with a high diagnostic yield in selected patients. In terms of complications of DBE, the study reported 3 cases of pancreatitis, all of which occurred after oral enteroscopy and were relieved by conservative treatment. Abdominal pain is common after DBE, occurring in approximately 20% of cases, and is usually self-limited (lasting no more than 24 hours)[30]. DBE can cause significant major complications, such as bowel perforation, pancreatitis, and aspiration pneumonia, but the incidence is lower than expected at 0.72%[31]. The three cases of digestive tract perforation complications that occurred in this center were considered to be related to the patients' own factors of digestive tract stenosis and digestive tract obstruction, and all three patients had a history of abdominal surgery in the past. DBE is a new colonoscopy method, and the penetration depth of transoral colonoscopy is generally longer, while the penetration depth of transanal colonoscopy is shorter due to the curvature of the large intestine and the history of abdominal surgery. Therefore, the jejunum can be examined and treated in almost all cases and the ileum can be examined and treated in most cases. The depth of insertion of a DBE and the success rate of a total colonoscopy depend on the level of surgery performed by the endoscopist and the patient. The main advantages of DBE over capsule colonoscopy are the possibility of endoscopic interventions such as argon plasma coagulation, polypectomy, tattooing for endoscopic follow−up or surgical intervention, and the possibility of foreign−body removal. DBE is a new endoscopic tool that can not only perform diagnostic tests for small intestine diseases, but also perform therapeutic interventions. However, for various reasons, endoscopic therapy appears to be more difficult to perform deep in the small intestine than in the upper or lower digestive tract. Common enteroscopy treatments include injection therapy, argon plasma coagulation, polypectomy, dilation therapy, foreign body removal, stent implantation, etc. Polypectomy of large polyps appears to be the procedure associated with the highest risk[32].. In addition, small bowel varicose veins are a rare consequence of portal hypertension, and studies have shown that DBE-facilitated cyanoacrylate injections appear to be a safe and effective option when other first-line treatment options are not available[33]. The data from this center shows that the depth of oral insertion is greater than that of anal insertion, and the depth of DBE is greater than that of SBE. By summarizing the clinical data of over 1,000 cases of enteroscopy in our center over a period of more than 10 years, we have found that enteroscopy has high diagnostic value for unexplained abdominal pain, gastrointestinal bleeding, CD, small intestinal tumors, and so on. Overall, enteroscopy is safe. The insertion depth of DBE is greater than that of SBE, and the insertion depth through the mouth is greater than that through the anus. Patients with general anesthesia have a good tolerance. The above-mentioned valuable experiences provide for clinical practice. Our research also has its limitations. Firstly, although the sample size of patients in our study is large, this research is only a single-center study, and the selection of patients may be biased in many aspects. Secondly, the number of cases where treatment under enteroscopy is carried out is small. All of these await further improvement through subsequent research. Abbreviations DBE Double balloon enteroscopy SBE Single balloon enteroscopy SBDs small bowel diseases OGIB obscure gastrointestinal bleeding APC argon plasma coagulation CD Crohn's disease CMUSE cryptogenic multifocal ulcerous stenosing enteritis Declarations Funding statement Anhui Province Health and Wellness Research Project of 2024 (Project Number: AHWJ2024BAf30035) Contributions Jiaqin Xu and Xiuli Zhu: Study design, Interpretation of histology samples, discussion, conclusion and approval of the final draft. Qiaomin Wang: Study design, Interpretation of histology samples. Xuemei Xu: conclusion and approval of the final draft. Li Xie: conclusion and approval of the final draft. Acknowledgments Thanks to WQM, XJQ and ZXL for providing data support, XXM and XL for participating in research planning and guidance. Informed consent/ Patient consent The medical records or biological specimens used in this study were obtained from previous clinical diagnosis and treatment, and will not cause physical and mental pain to patients, affect the safety and health of patients, increase the economic burden of patients and their families, and exemption from informed consent will not adversely affect the rights and health of patients. Informed consent/ Patient consent. Trial registration number/date This study has been approved by the Ethics Committee of Anhui Provincial Hospital. Ethics approval and consent to participate Availability of data and materials The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions. Informed consent was obtained from all study participants. The medical records or biological specimens used in this study were obtained from previous clinical diagnosis and treatment, and will not cause physical and mental pain to patients, affect the safety and health of patients, increase the economic burden of patients and their families, and exemption from informed consent will not adversely affect the rights and health of patients. The present study was approved by the Ethics Committee of The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China. Consent for publication Not applicable. Conflicts of Interest The authors declared that they have no conflicts of interest to this work. We declare that we do not have any commercial or associative interest that represents a conflict of interest in connection with the work submitted. References Almeida N, Figueiredo P, Lopes S ,et al.Double-Balloon Enteroscopy and Small Bowel Tumors: A South-European Single-Center Experience[J].Dig Dis, 2009, 54(7):1520–1524. MAY A. Balloon enteroscopy: single- and double-balloon enteroscopy.[J]. Gastrointestinal endoscopy clinics of North America,2009,19(3):349–356. amamoto H, Sekine Y, Sato Y, et al. Total enteroscopy with a nonsurgical steerable double-balloon method. Gastrointest Endosc 2001;53:216–20. KAWAMURA T, YASUDA K, TANAKA K, et al. Clinical evaluation of a newly developed single-balloon enteroscope.[J]. Gastrointestinal Endoscopy,2008,68(6):1112–1116. Hartmann D, Eickhoff A, Tamm R et al. Balloon-assisted enteroscopy using a single-balloon technique. Endoscopy 2007; 39 Suppl 1: E276. RAMCHANDANI M, REDDY DN, GUPTA R. Diagnostic yield and therapeutic impact of single-balloon enteroscopy: series of 106 cases.[J]. Journal of gastroenterology and hepatology,2009,24(10):1631–1638. Park SB. Application of double-balloon enteroscopy for small bowel tumors. Clin Endosc. 2023 Jan;56(1):53–54. Yamamoto H, Kita H, Sunada K, et al. Clinical outcomes of double-balloon endoscopy for the diagnosis and treatment of small-intestinal diseases. Clin Gastroenterol Hepatol 2004;2:1010–6. Tsujikawa T, Saitoh Y, Andoh A, et al. Novel single-balloon enteroscopy for diagnosis and treatment of the small intestine: preliminary experiences. Endoscopy 2008;40:11–5. DOMAGK D, MENSINK P, AKTAS H, et al. Single- vs. double-balloon enteroscopy in small-bowel diagnostics: a randomized multicenter trial.[J]. Endoscopy: Journal for Clinical Use Biopsy and Technique,2011,43(6):472–476. Zaman A, Katon R M .Push enteroscopy for obscure gastrointestinal bleeding yields a high incidence of proximal lesions within reach of a standard endoscope[J].Gastrointestinal Endoscopy, 1998, 47(5):372–376. Zuckerman GR, Prakash C, Askin MP, et al. AGA technical review on the evaluation and management of occult and obscure gastrointestinal bleeding. Gastroenterology. 2000 Jan;118(1):201 − 21. Cazzato IA, Cammarota G, Nista EC, Cesaro P, Sparano L, Bonomo V, Gasbarrini GB, Gasbarrini A. Diagnostic and therapeutic impact of double-balloon enteroscopy (DBE) in a series of 100 patients with suspected small bowel diseases. Dig Liver Dis. 2007 May;39(5):483-7. MOSCHLER O, MAY A, MULLER MK, et al. Complications in and performance of double-balloon enteroscopy (DBE): results from a large prospective DBE database in Germany.[J]. Endoscopy: Journal for Clinical Use Biopsy and Technique,2011,43(6):484–489. Sato Y, Matsui T, Yano Y, et al. Long-term course of Crohn's disease in Japan: Incidence of complications, cumulative rate of initial surgery, and risk factors at diagnosis for initial surgery. J Gastroenterol Hepatol. 2015 Dec;30(12):1713-9. Van Assche G, Geboes K, Rutgeerts P. Medical therapy for Crohn's disease strictures. Inflamm Bowel Dis. 2004 Jan;10(1):55–60. Navaneethan U, Lourdusamy V, Njei B, Shen B. Endoscopic balloon dilation in the management of strictures in Crohn's disease: a systematic review and meta-analysis of non-randomized trials. Surg Endosc. 2016 Dec;30(12):5434–5443. Bettenworth D, Gustavsson A, Atreja A, et al. A Pooled Analysis of Efficacy, Safety, and Long-term Outcome of Endoscopic Balloon Dilation Therapy for Patients with Stricturing Crohn's Disease. Inflamm Bowel Dis. 2017 Jan;23(1):133–142. Bamba S, Sakemi R, Fujii T, et al. A nationwide, multi-center, retrospective study of symptomatic small bowel stricture in patients with Crohn's disease. J Gastroenterol. 2020 Jun;55(6):615–626. Schottenfeld D, Beebe-Dimmer JL, Vigneau FD. The epidemiology and pathogenesis of neoplasia in the small intestine. Ann Epidemiol. 2009 Jan;19(1):58–69. Zagorowicz ES, Pietrzak AM, Wronska E, et al. Small bowel tumors detected and missed during capsule endoscopy: single center experience. World J Gastroenterol. 2013 Dec 21;19(47):9043-8. Inoue Y, Hayashi M, Satou N, et al. Prognostic clinicopathological factors after curative resection of small bowel adenocarcinoma. J Gastrointest Cancer. 2012 Jun;43(2):272-8. Alfagih A, Alrehaili M, Asmis T. Small Bowel Adenocarcinoma: 10-Year Experience in a Cancer Center-The Ottawa Hospital (TOH). Curr Oncol. 2022 Oct 5;29(10):7439–7449. Zhang C, Hong L, Zhang T, Sun P, Sun J, Zhou J, Wang L, Fan R, Wang Z, Cheng S, Zhong J. Clinical characteristics of small bowel tumors diagnosed by double-balloon endoscopy: Experience from a Chinese tertiary hospital. Turk J Gastroenterol. 2020 Jan;31(1):30–35. Sun B et al. The role of double − balloon enteroscopy in diagnosis and management of incomplete small − bowel obstruction. Endoscopy 2007; 39: 511–515. AKTAS H, DE RIDDER L, HARINGSMA J, et al. Complications of single-balloon enteroscopy: a prospective evaluation of 166 procedures.[J]. Endoscopy: Journal for Clinical Use Biopsy and Technique,2010,42(5):365–368. MANNO M, BARBERA C, DABIZZI E, et al. Safety of single-balloon enteroscopy: our experience of 72 procedures.[J]. Endoscopy: Journal for Clinical Use Biopsy and Technique,2010,42(9):773–774. MAY A. Balloon enteroscopy: single- and double-balloon enteroscopy.[J]. Gastrointestinal endoscopy clinics of North America,2009,19(3):349–356. Manno M, Barbera C, Bertani H, et al. Single balloon enteroscopy: Technical aspects and clinical applications. World J Gastrointest Endosc 2012; 4(2): 28–32. Heine GD, Hadithi M, Groenen MJ, Kuipers EJ, Jacobs MA, Mulder CJ. Double-balloon enteroscopy: indications, diagnostic yield, and complications in a series of 275 patients with suspected small-bowel disease. Endoscopy. 2006 Jan;38(1):42 − 8. Xin L, Liao Z, Jiang YP, et al. Indications, detectability, positive findings, total enteroscopy, and complications of diagnostic double balloon endoscopy: a systematic review of data over the first decade of use. Gastrointest Endosc 2011;74:563–570. May A, Nachbar L, Pohl J, Ell C. Endoscopic interventions in the small bowel using double balloon enteroscopy: feasibility and limitations. Am J Gastroenterol. 2007 Mar;102(3):527 − 35. Despott EJ, May A, Lazaridis N, et al. Double-balloon enteroscopy-facilitated cyanoacrylate-injection endotherapy of small-bowel varices: an international experience from 2 European tertiary centers (with videos). Gastrointest Endosc. 2019 Aug;90(2):302–306. Tables Table 1. The basic information of the patient. Parameters Number Total 1215 Age,year 41.67±15.75 Gender Male 801（65.9%） Female 414（34.1%） General anesthesia Yes 899（74.0%） No 316（26.0%） DBE 297（24.4%） SBE 918（75.6%） Year of operation Before 2020 (including 2020） 357（29.4%） After 2020 858（70.6%） Inspection method oral 210（17.3%） anal 814（67.0%） oral and anal 191（15.7%） Transoral depth, m 2.02±0.98 Transanal depth, m 1.16±1.65 Symptoms abdominal pain 499（41.1%） follow-up examination for CD 266（21.9%） gastrointestinal bleeding 199（16.4%） diarrhea 183（15.1%） Others (abdominal distension, vomiting, anemia, fever, etc.) 68（5.5%） Table 2. The result of the enteroscopy examination. Result of the enteroscopy N（n%） CD or suspected CD 555（45.7%） Small bowel ulcers and erosions (bowel tuberculosis, Behcet's disease, nonspecific inflammation or undiagnosed) 210（17.3%） Negative（The result is normal or cannot explain the cause of the patient's illness） 162（13.3%） Tumor 77（6.3%） Small bowel vascular malformations 68（5.6%） Others (diverticula, foreign bodies, villous atrophy, allergic purpura, etc.) 143（11.8%） Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7584481","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":531806932,"identity":"7dd10f4b-75b6-4308-8abc-5502354367cc","order_by":0,"name":"Jiaqin Xu","email":"","orcid":"","institution":"The First Affiliated Hospital of USTC, University of Science and Technology of China","correspondingAuthor":false,"prefix":"","firstName":"Jiaqin","middleName":"","lastName":"Xu","suffix":""},{"id":531806933,"identity":"610c6dea-d3a4-417f-a2b6-ebc62bcdd69b","order_by":1,"name":"Qiaomin Wang","email":"","orcid":"","institution":"The First Affiliated Hospital of USTC, University of Science and Technology of China","correspondingAuthor":false,"prefix":"","firstName":"Qiaomin","middleName":"","lastName":"Wang","suffix":""},{"id":531806934,"identity":"9a7b35d5-2222-43e6-9c6c-d775cd952efb","order_by":2,"name":"Li Xie","email":"","orcid":"","institution":"The First Affiliated Hospital of USTC, University of Science and Technology of China","correspondingAuthor":false,"prefix":"","firstName":"Li","middleName":"","lastName":"Xie","suffix":""},{"id":531806935,"identity":"bbc9b950-99e1-4fd4-9209-448a4458d10d","order_by":3,"name":"Xuemei Xu","email":"","orcid":"","institution":"The First Affiliated Hospital of USTC, University of Science and Technology of China","correspondingAuthor":false,"prefix":"","firstName":"Xuemei","middleName":"","lastName":"Xu","suffix":""},{"id":531806936,"identity":"8ef68b32-b920-4f1a-acf3-d0e7781253cc","order_by":4,"name":"Xiuli Zhu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAz0lEQVRIiWNgGAWjYBACNvbGxgcfeGp4+NmbDxCnhY/ncLPhDJljcpI9xxKI0yInkd4mzGPDbGxwI8eASIcxJLYx8OSwJW64kfPxxhsGOzndBoJaDrY9kDgjkzjzzNvNlnMYko3NDhDSwtjYbmDYw5bYdzx3mzQPw4HEbQS1MDO2SST+Y05sOJDzjEgtbEAtB3iYjQVO5LARqYWHsdmwgQccyMaWcwyI8Iv8/OcPH/+BROXDG28q7OQIakEBEjxERg2yFlJ1jIJRMApGwYgAAGB4Q3MvLZtBAAAAAElFTkSuQmCC","orcid":"","institution":"The First Affiliated Hospital of USTC, University of Science and Technology of China","correspondingAuthor":true,"prefix":"","firstName":"Xiuli","middleName":"","lastName":"Zhu","suffix":""}],"badges":[],"createdAt":"2025-09-10 15:38:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7584481/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7584481/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":94137434,"identity":"6e79115e-dcbc-4fe8-8835-3e0d03ab791e","added_by":"auto","created_at":"2025-10-22 19:23:11","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":164554,"visible":true,"origin":"","legend":"","description":"","filename":"file.docx","url":"https://assets-eu.researchsquare.com/files/rs-7584481/v1/bb24f1992b4d275b25d461ac.docx"},{"id":94137436,"identity":"31dae2a1-a717-4011-9825-8f7ceeb923e1","added_by":"auto","created_at":"2025-10-22 19:23:11","extension":"doc","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":113152,"visible":true,"origin":"","legend":"","description":"","filename":"file.doc","url":"https://assets-eu.researchsquare.com/files/rs-7584481/v1/9d1098bda89b285156f5eaaa.doc"},{"id":94139004,"identity":"ef6aedf7-26cb-4646-89af-22df780aee82","added_by":"auto","created_at":"2025-10-22 19:31:11","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":164554,"visible":true,"origin":"","legend":"","description":"","filename":"d1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7584481/v1/7cac4a44d76d1a43d16acd2b.docx"},{"id":94137433,"identity":"21dae773-1637-4c0b-a1cc-e46f2af5fcb2","added_by":"auto","created_at":"2025-10-22 19:23:11","extension":"json","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":7103,"visible":true,"origin":"","legend":"","description":"","filename":"446d5f72ecb946689e4ecf9a6b30eacb.json","url":"https://assets-eu.researchsquare.com/files/rs-7584481/v1/a3ec6c6d317264c9fe4c3e84.json"},{"id":94137439,"identity":"0825bb0d-c64f-41c5-b376-8c0c7ada50c3","added_by":"auto","created_at":"2025-10-22 19:23:11","extension":"xml","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":110308,"visible":true,"origin":"","legend":"","description":"","filename":"446d5f72ecb946689e4ecf9a6b30eacb1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7584481/v1/ac816dd6c95a56198557f2d4.xml"},{"id":94137437,"identity":"2cd2ba83-5ace-42b1-a19a-ab6604daafa0","added_by":"auto","created_at":"2025-10-22 19:23:11","extension":"jpeg","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":141745,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7584481/v1/c82486f10a9a6106b8047634.jpeg"},{"id":94137441,"identity":"01e9533b-9fd2-4867-a1f3-bdb189fe98db","added_by":"auto","created_at":"2025-10-22 19:23:11","extension":"png","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":101604,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7584481/v1/222e6401ac5c97570df82efa.png"},{"id":94137440,"identity":"bc603ff2-d407-45dd-9275-b6e4bc8959c2","added_by":"auto","created_at":"2025-10-22 19:23:11","extension":"xml","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":108647,"visible":true,"origin":"","legend":"","description":"","filename":"446d5f72ecb946689e4ecf9a6b30eacb1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7584481/v1/60e86b27633e429eb837362a.xml"},{"id":94137445,"identity":"d518bc04-1d2f-4622-8d7c-8262e047e362","added_by":"auto","created_at":"2025-10-22 19:23:11","extension":"html","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":122085,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7584481/v1/4e2e2adb3f6cbefeeead9825.html"},{"id":94137432,"identity":"8e9525c1-eacd-4ffd-9e35-19f6a53a5027","added_by":"auto","created_at":"2025-10-22 19:23:11","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":42351,"visible":true,"origin":"","legend":"\u003cp\u003eBasic information of enteroscopy from July 2015 to July 2025\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7584481/v1/f6d5bff3d01ad8079a7bd0a2.png"},{"id":94139003,"identity":"79814139-212e-4d10-8721-0d4f4711fe14","added_by":"auto","created_at":"2025-10-22 19:31:11","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":956679,"visible":true,"origin":"","legend":"\u003cp\u003eTypical pictures of small bowel diseases. A is small bowel adenocarcinoma, B is small bowel vascular malformation, C is small bowel CD capsule endoscopy stuck at the stenotic site, D is B-cell lymphoma, E is Meckel diverticulum, F and G are CMUSE, H is stenotic small bowel CD.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7584481/v1/41086e5abd82797d51a3573d.png"},{"id":94984950,"identity":"66a46578-de47-4fd1-b44a-c7c0fd3af22c","added_by":"auto","created_at":"2025-11-03 06:57:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1945426,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7584481/v1/9163f1da-f467-45a0-a64d-516d35296e73.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003e10 years - Over 1000 cases - Summary and analysis of enteroscopy, a single-center retrospective study\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe small intestine accounts for about 75% of the gastrointestinal tract, and its mucosa accounts for about 90% of the surface area of the intestinal cavity. The small intestine, long and curved, was the blind area of digestive endoscopy for a long time, until the advent of video capsule endoscopy and balloon endoscopy, a breakthrough in the field of small intestine examination[1]. Capsule endoscopy is a safe method, and in most cases the entire small intestine can be seen under the endoscope, but a major disadvantage of this method is the inability to obtain a histological sample and perform endoscopic treatment[2]. Due to the unique anatomical characteristics of the small intestine, capsule endoscopy has certain blind areas, and there is a relative contraindication in patients with stenosis and obstruction. Enteroscopy makes up for this lack, allowing intuitive exploration without dead corners, biopsy and treatment. Of course, it is an invasive operation with risks such as bleeding, perforation and infection. Enteroscopy includes single balloon enteroscopy (SBE) and double balloon enteroscopy (DBE). DBE system consists of a high-resolution video endoscope with a working length of 200cm and consists of a flexible upper tube made of polyurethane. The latex balloon is attached to the tip and upper tube of the enteroscopy and can be filled with air or emptied with a pressure-controlled pump. The principle of DBE technology is based on alternating propulsion and traction operations that allow the small intestine to be attached to the outer cannula step by step[3]. In 2008, Olympus introduced a new, simplified SBE that uses one balloon instead of two to facilitate access to the small intestine. In theory, the use of this SBE system may reduce preparation and examination time. However, SBE may be less efficient than DBE for deep intubation of the small intestine and may cause adverse reactions due to the use of the hook technique during single balloon endoscopic straightening[4-5]. Small bowel diseases(SBDs) including obscure gastrointestinal bleeding (OGIB), unexplained abdominal pain, chronic diarrhea, various small bowel ulcers including infection, tumor, inflammatory bowel disease, Crohn\u0026apos;s disease(CD), celiac disease, familial polyposis, and so on, can be diagnosed and treated by endoscopy[6-7]. Non-surgical treatment of SBDs is difficult. This is due to the lack of appropriate research models to venture into long redundant small intestine circulation. Balloon enteroscopy performs aspiration and irrigation through instrumental channels, sampling biopsy, and therapeutic interventions such as argon plasma coagulation (APC) , submucosal injection, clip location, polyp resection, dilation, and foreign body removal.\u003c/p\u003e\n\u003cp\u003eTo date, an increasing number of global studies have reported on the diagnostic and therapeutic value of DBE and SBE in managing small intestinal diseases. However, most of these studies are limited by small sample sizes or are multicenter in nature, with the majority of clinical experience originating from Japan and Europe. Data regarding the application and outcomes of balloon enteroscopy in China remain limited.\u003c/p\u003e\n\u003cp\u003eBased on over a decade of clinical data from more than 1,000 enteroscopy cases, our study primarily analyzed the indications for enteroscopy, lesion detection rates, and its comparative advantages relative to small bowel CT and capsule endoscopy. The objective of this research is to evaluate the diagnostic efficacy of enteroscopy in small intestinal diseases and provide clinically relevant insights for routine practice.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design and Patient Population\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study is a single-center, retrospective observational study spanning a 10-year period. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInclusion criteria: All patients who underwent balloon-assisted enteroscopy at our institution between January 2015 and July 2025 were included. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eExclusion criterion:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e(1) Due to the long duration of the study period, multiple hospital information system upgrades occurred, resulting in incomplete or missing enteroscopy records. Patients with such incomplete data were excluded from the analysis. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e(2) Patients for whom the insertion depth during transoral or transanal enteroscopy was not documented were also excluded.\u003c/p\u003e\n\u003cp\u003eThis study has been approved by the Medical Ethics Committee of the First Affiliated Hospital of University of Science and Technology of China.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePerioperative preparation for enteroscopy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e(1) The patient did not drink or eat after 10 p.m. the previous night, and received an oral enteroscopy on an empty stomach the next day. Transanal enteroscopy requires bowel cleaning the day before.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e(2) The initial insertion route of the enteroscopy (anal or oral) is selected based on clinical presentation and imaging findings, if any, based on the estimated location of the suspected lesion. Lesions expected to be located in the upper two-thirds of the small intestine are examined orally first, while other lesions begin with anal examination and are examined both orally and transanal if necessary. The examination continued until the target lesion was reached, or until no further progress was deemed possible.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e(3) The whole procedure was performed through the cooperation of two doctors and one nurse.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e(4) Patients can receive intravenous general anesthesia or tracheal intubation anesthesia, usually poor cardiopulmonary function, transoral enteroscopy requires tracheal intubation anesthesia. During DBE/SBE, oxygen was inhaled with electrocardiographic monitoring.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCollect the basic and clinical data of the patients, including gender, age, examination date, anesthesia method, transoral or transanal enteroscopy, endoscopic insertion depth, examination results, complications, and consistency with the diagnosis of small bowel CT or capsule endoscopy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQuantitative variables were represented as mean \u0026plusmn; SD or as median with interquartile range and compared using Student\u0026apos;s t-test or nonparametric tests. The categorical variables were expressed in counts (percentages) and analyzed using the chi-square test or Fisher\u0026apos;s exact test. A p-value less than 0.05 (double tailed) was considered significant. All statistical analyses were performed in SPSS version 25.0.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003e1. The basic information\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUltimately, 1,215 patients were enrolled in the study. The mean age was 41.67\u0026plusmn;15.75 year. There were 801 male patients and 414 female patients. Among them, 899 (74.0%) patients received general anesthesia, while 316 (26.0%) patients received non-general anesthesia. 297 (24.4%) patients underwent DBE, and 918 (75.6%) patients underwent SBE. A total of 357 cases occurred before 2020 (inclusive), and 858 cases occurred after 2020. 210 (17.3%) patients underwent oral enteroscopy, 814 (67.0%) patients underwent anal enteroscopy, and 191 (15.7%) patients underwent combined oral and anal enteroscopy. A total of 27 cases of full small bowel examination were completed. The mean oral insertion depth was 2.02\u0026plusmn;0.98 meters, and the anal insertion depth was 1.16\u0026plusmn;1.65 meters. Regarding the insertion depth of endoscopy, for SBE, the insertion depth is 1.99+0.94 meters through the oral and 1.17+1.86 meters through the anal. For DBE, the insertion depth is 2.08+1.08 through the oral and 1.12+0.66 through the anal. The insertion depth through the oral is greater than that through the anal, and the insertion depth of the DBE is greater than that of the SBE. The reasons for patients to undergo enteroscopy varied. These mainly included abdominal pain (41.1%), regular follow-up for CD (21.9%), gastrointestinal bleeding, diarrhea, and others (such as abdominal distension, vomiting, anemia, and fever). The general information of the patients is presented in \u003cstrong\u003eTable 1\u003c/strong\u003e. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2. The inspection situation of each year\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFrom July 2015 to July 2025, the total volume of enteroscopy examinations at our center has been increasing year by year. Among them, the growth rate was relatively high in 2019 and 2021. The total volume decreased in several years due to the COVID-19 pandemic and the suspension of endoscopy maintenance. There was only one failed case of enteroscopy in our center. The patient was suspected of having CD and the enteroscopy was performed through the anus to the sigmoid colon without general anesthesia. The pain was unbearable and the patient could not tolerate it, so the examination was terminated. Since 2018, our center has attempted to perform enteroscopy under general anesthesia. The patient\u0026apos;s tolerance has improved, and the overall examination volume has increased. All enteroscopy procedures have been successfully completed. The volume of SBE is significantly higher than that of DBE, which may be related to the fact that the number of patients in the central campus (where SBE is carried out) of this center is larger than that in the South campus (where DBE is carried out). For detailed information, please refer to \u003cstrong\u003eFigure 1\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3. Analysis of colonoscopy results\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUltimately, through enteroscopy, 555 (45.7%) cases of CD or suspected CD, 210 (17.3%) cases of non-CD small bowel ulcers and erosions (bowel tuberculosis, Behcet\u0026apos;s disease, nonspecific inflammation or undiagnosed), 162 (13.3%) cases of negative results (The result is normal or cannot explain the cause of the patient\u0026apos;s illness), 77 (6.3%) cases of small bowel tumors, 68 (5.6%) cases of small bowel vascular malformations, and 143 (11.8%) other cases were diagnosed including diverticula, foreign bodies, villous atrophy, allergic purpura, and so on . See \u003cstrong\u003eTable 2\u003c/strong\u003e for details.\u003c/p\u003e\n\u003cp\u003eA total of 867 patients underwent enhanced CT examinations of the small bowel. Among these patients, the CT diagnoses of 707 cases were largely consistent with those obtained through enteroscopy. The diagnostic consistency between CT and enteroscopy was relatively high for small bowel space-occupying lesions and CD. In 160 cases, the diagnoses did not match those of enteroscopy, including small bowel vascular diseases, diverticula, and congestion with mucosal erosion. Additionally, a total of 45 patients underwent capsule endoscopy. Of these, 27 cases showed diagnoses consistent with enteroscopy, primarily involving CD and small bowel space-occupying lesions. In 18 cases, the diagnoses were inconsistent with those of enteroscopy, mainly involving small bowel space-occupying lesions and vascular malformations.\u003c/p\u003e\n\u003cp\u003e4. \u003cstrong\u003eSafety and complications\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOne patient discontinued the small bowel endoscopy due to severe pain and an inability to tolerate the procedure without general anesthesia. A total of three patients experienced gastrointestinal perforation complications either during the examination or within 24 hours post-examination. Of these, two cases showed improvement following surgical intervention, while the remaining case resolved with conservative management. Among the patients with digestive tract perforation, two cases were of CD stenosis type, one case was a patient with bowel infarction and bowel obstruction, one case underwent oral enteroscopy, and two cases underwent anal enteroscopy, all of which were SBE. No other significant complications, such as gastrointestinal bleeding, infection, or pancreatitis, were observed in the remaining patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e5. Typical case\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFigure 2 presents images of several typical small bowel diseases diagnosed at our center. Case A involves a 49-year-old female patient who presented with abdominal pain and was subsequently diagnosed with small bowel adenocarcinoma. Case B is a 54-year-old male who sought medical attention due to gastrointestinal bleeding and was ultimately diagnosed with small bowel vascular malformation. Case C is a 50-year-old male who presented with abdominal pain and diarrhea. Capsule endoscopy revealed multiple ulcers in the small intestine, and the capsule became lodged in the small bowel. The capsule endoscope was later retrieved via enteroscopy, and the patient was diagnosed with small bowel CD. Case D is a 59-year-old female who presented with diarrhea and was ultimately diagnosed with B-cell lymphoma. Case E is a 14-year-old male who visited the hospital due to gastrointestinal bleeding and was finally diagnosed with Meckel diverticulum. Cases F and G are both 38-year-old males who presented with abdominal pain and anemia; both were ultimately diagnosed with cryptogenic multifocal ulcerous stenosing enteritis (CMUSE). Case H is a 22-year-old male who presented with abdominal pain and was ultimately diagnosed with stenostrictive Crohn\u0026rsquo;s disease.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eSBDs lack specific signs and symptoms, and diagnosis and treatment is a difficult task for clinicians. Since the 21st century, capsule endoscopy and enteroscopy have emerged as new endoscopic methods for small intestine exploration, which can directly see the inside of the small intestine. In optimal case, the entire small intestine, or at least a sizable portion, can be examined using a balloon colonoscopy. Depending on the experience level of the endoscopist, total colonoscopy using the double balloon method is about 40% to 80%(up to 86%), and SBE is currently up to 25% before 2008. In recent years, with the improvement of the level of endoscopists, the success rate of whole small intestine examination has also been greatly improved[8,9]. A head-to-head comparison study shows that DBE and SBE have a comparable performance and diagnostic yield for evaluation of the small intestine, accordingly, both techniques seem to be interchangeable in daily small intestine examination[10]. During the DBE, the esophagus, the stomach, and the colon are reexamined, and missed lesions can be located and treated. Previous studies on push enteroscopy and capsule endoscopy have shown that up to 25% of patients with recurrent gastrointestinal bleeding had a bleeding source within the reach of the gastroscope[11,12]. Using data from a standard questionnaire, the German researchers established a prospective database of all DBE examinations at 62 endoscopic centers, including personal information, indications, surgical information, interventions, diagnoses, and complications. Over a 2-year period, 2,245 DBE tests were performed on 1,765 patients. The most common test pointer is small intestine bleeding, and the most frequent intervention was argon plasma coagulation of angiodysplasia. There were 27 complications, and the complication rate for all tests was 1.2%[13]. In a 2007 prospective study evaluating the impact of double balloon colonoscopy on the diagnosis and treatment of patients with suspected or documented small bowel disease, a total of 118 double balloon colonoscopies were performed, with an overall diagnosis rate of 69%, the most common narrowness manifestations include vascular dysplasia, ulcers and erosion of various etiologies, tumors, and small intestine stenosis in patients suspected of Crohn\u0026apos;s disease[14]. Our research analyzed and summarized the reasons why patients underwent enteroscopy and found that the reasons varied among these patients, mainly including abdominal pain (41.1%), regular follow-up of celiac disease (21.9%), gastrointestinal bleeding, diarrhea and others (such as abdominal distension, vomiting, anemia and fever).\u003c/p\u003e\n\u003cp\u003eMany patients in our center have undergone enteroscopy due to suspected CD, regular follow-up for CD, or due to complications in CD patients, accounting for 266 (21.9%). CD is a chronic granulomatous inflammatory bowel disease characterized by leaping lesions and transmural inflammation that can involve the entire digestive tract from the oral cavity to the anus. Common complications include gastrointestinal bleeding, perforation, and obstruction caused by stenosis. CD lesions often involve the ileum and colon, but stenosis is more likely to occur in the small intestine than the colon[15]. Therefore, CD patients most often receive surgical treatment for small bowel stenosis. Treatment options for patients with CD stenosis are medication, endoscopic therapy, usually endoscopic balloon dilatation (EBD), and surgery, including stenoplasty[16]. Enteroscopy dilation therapy brings benefits to CD patients, can reduce or delay surgery, greatly reduce trauma. EBD is a minimally invasive procedure with a high success rate and a low rate of surgical complications, however, patients need to undergo repeated procedures to avoid surgery, which ultimately reduces quality of life[17-19]. Three patients with stenotic CD in this center underwent EBD or endoscopic incision surgery under enteroscopy. They recovered well during the operation and had no obvious complications.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOur center diagnosed 77 cases (6.3%) of small bowel space-occupying lesions through enteroscopy. Pathology confirmed that stromal tumors and lymphomas were the most common. The incidence of small intestine tumors is not high, accounting for about 2-5% of all digestive systems. However, most small intestine tumors are malignant or have malignant potential, including gastrointestinal stromal tumors (gist), lymphomas, primary adenocarcinomas [1] tumors, and neuroendocrine tumors. They have no clinical symptoms in the early stages and are difficult to pass routine endoscopy due to their deep location. Therefore, early detection of small intestine tumors is extremely difficult[20-23]. A retrospective study found that DBE was a reliable method for diagnosing small bowel tumors, which were predominantly located in the jejunum and were characterized by unexplained gastrointestinal bleeding and abdominal pain[24]. A prospective study found that double-balloon colonoscopy is a viable diagnostic tool for patients with incomplete small bowel obstruction without a history of abdominal surgery, and for patients whose cause is not clear from routine radiography. The most frequent causes of small bowel obstruction are postoperative adhesions and hernias. However, the most common cause in patients without a history of abdominal surgery is small intestine tumors and stenosis[25]. Our research also found that for small bowel space-occupying lesions and CD, the diagnostic consistency between small bowel enhanced CT and enteroscopy is relatively high, but the diagnostic value of small bowel enhanced CT for small bowel vascular malformations, small bowel diverticula, and mucosal erosion is not high. Capsule endoscopy has a relatively high diagnostic value for small bowel vascular malformations.\u003c/p\u003e\n\u003cp\u003eDespite the use of balloons, the location of the deep small intestine is sometimes unstable, and flexibility is limited because the small intestine is screwed onto the outer cannula, in addition, the small intestine wall is very thin. For all these reasons, the complication rate is likely to be higher than that with procedures in the upper and lower gastrointestinal tract. Complications of enteroscopy include gastrointestinal bleeding, perforation, infection, pancreatitis, etc., the incidence is generally very low. The occurrence of complications was related to the operation level of endoscopists, the general condition of patients, the history of abdominal surgery, and the history of hormone and immunosuppressive therapy[26,27]. Balloon enteroscopy appears to be a safe procedure. However, when passing a small bowel lesion or in patients with known adhesions or strictures, careful operation is required. As in conventional endoscopy, the risk is higher in therapeutic enteroscopy[28,29]. A large pilot series shows that DBE is a well tolerated and safe new endoscopic technique with a high diagnostic yield in selected patients. In terms of complications of DBE, the study reported 3 cases of pancreatitis, all of which occurred after oral enteroscopy and were relieved by conservative treatment. Abdominal pain is common after DBE, occurring in approximately 20% of cases, and is usually self-limited (lasting no more than 24 hours)[30]. DBE can cause significant major complications, such as bowel perforation, pancreatitis, and aspiration pneumonia, but the incidence is lower than expected at 0.72%[31]. The three cases of digestive tract perforation complications that occurred in this center were considered to be related to the patients\u0026apos; own factors of digestive tract stenosis and digestive tract obstruction, and all three patients had a history of abdominal surgery in the past. DBE is a new colonoscopy method, and the penetration depth of transoral colonoscopy is generally longer, while the penetration depth of transanal colonoscopy is shorter due to the curvature of the large intestine and the history of abdominal surgery. Therefore, the jejunum can be examined and treated in almost all cases and the ileum can be examined and treated in most cases. The depth of insertion of a DBE and the success rate of a total colonoscopy depend on the level of surgery performed by the endoscopist and the patient. The main advantages of DBE over capsule colonoscopy are the possibility of endoscopic interventions such as argon plasma coagulation, polypectomy, tattooing for endoscopic follow\u0026minus;up or surgical intervention, and the possibility of foreign\u0026minus;body removal. DBE is a new endoscopic tool that can not only perform diagnostic tests for small intestine diseases, but also perform therapeutic interventions. However, for various reasons, endoscopic therapy appears to be more difficult to perform deep in the small intestine than in the upper or lower digestive tract. Common enteroscopy treatments include injection therapy, argon plasma coagulation, polypectomy, dilation therapy, foreign body removal, stent implantation, etc. Polypectomy of large polyps appears to be the procedure associated with the highest risk[32].. In addition, small bowel varicose veins are a rare consequence of portal hypertension, and studies have shown that DBE-facilitated cyanoacrylate injections appear to be a safe and effective option when other first-line treatment options are not available[33]. The data from this center shows that the depth of oral insertion is greater than that of anal insertion, and the depth of DBE is greater than that of SBE.\u003c/p\u003e\n\u003cp\u003eBy summarizing the clinical data of over 1,000 cases of enteroscopy in our center over a period of more than 10 years, we have found that enteroscopy has high diagnostic value for unexplained abdominal pain, gastrointestinal bleeding, CD, small intestinal tumors, and so on. Overall, enteroscopy is safe. The insertion depth of DBE is greater than that of SBE, and the insertion depth through the mouth is greater than that through the anus. Patients with general anesthesia have a good tolerance. The above-mentioned valuable experiences provide for clinical practice. Our research also has its limitations. Firstly, although the sample size of patients in our study is large, this research is only a single-center study, and the selection of patients may be biased in many aspects. Secondly, the number of cases where treatment under enteroscopy is carried out is small. All of these await further improvement through subsequent research.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eDBE\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eDouble balloon enteroscopy\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSBE\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eSingle balloon enteroscopy\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSBDs\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003esmall bowel diseases\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eOGIB\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eobscure gastrointestinal bleeding\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAPC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eargon plasma coagulation\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCrohn's disease\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCMUSE\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ecryptogenic multifocal ulcerous stenosing enteritis\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnhui Province Health and Wellness Research Project of 2024 (Project Number: AHWJ2024BAf30035)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJiaqin Xu and Xiuli Zhu: Study design, Interpretation of histology samples, discussion, conclusion and approval of the final draft.\u003c/p\u003e\n\u003cp\u003eQiaomin Wang: Study design, Interpretation of histology samples.\u003c/p\u003e\n\u003cp\u003eXuemei Xu: conclusion and approval of the final draft.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLi Xie: conclusion and approval of the final draft.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThanks to WQM, XJQ and ZXL for providing data support, XXM and XL for participating in research planning and guidance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent/ Patient consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe medical records or biological specimens used in this study were obtained from previous clinical diagnosis and treatment, and will not cause physical and mental pain to patients, affect the safety and health of patients, increase the economic burden of patients and their families, and exemption from informed consent will not adversely affect the rights and health of patients.\u003c/p\u003e\n\u003cp\u003eInformed consent/ Patient consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration number/date\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study has been approved by the Ethics Committee of Anhui Provincial Hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all study participants. The medical records or biological specimens used in this study were obtained from previous clinical diagnosis and treatment, and will not cause physical and mental pain to patients, affect the safety and health of patients, increase the economic burden of patients and their families, and exemption from informed consent will not adversely affect the rights and health of patients.\u003c/p\u003e\n\u003cp\u003eThe present study was approved by the Ethics Committee of The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declared that they have no conflicts of interest to this work. We declare that we do not have any commercial or associative interest that represents a conflict of interest in connection with the work submitted.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAlmeida N, Figueiredo P, Lopes S ,et al.Double-Balloon Enteroscopy and Small Bowel Tumors: A South-European Single-Center Experience[J].Dig Dis, 2009, 54(7):1520\u0026ndash;1524.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMAY A. Balloon enteroscopy: single- and double-balloon enteroscopy.[J]. Gastrointestinal endoscopy clinics of North America,2009,19(3):349\u0026ndash;356.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eamamoto H, Sekine Y, Sato Y, et al. Total enteroscopy with a nonsurgical steerable double-balloon method. Gastrointest Endosc 2001;53:216\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKAWAMURA T, YASUDA K, TANAKA K, et al. Clinical evaluation of a newly developed single-balloon enteroscope.[J]. Gastrointestinal Endoscopy,2008,68(6):1112\u0026ndash;1116.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHartmann D, Eickhoff A, Tamm R et al. Balloon-assisted enteroscopy using a single-balloon technique. Endoscopy 2007; 39 Suppl 1: E276.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRAMCHANDANI M, REDDY DN, GUPTA R. Diagnostic yield and therapeutic impact of single-balloon enteroscopy: series of 106 cases.[J]. Journal of gastroenterology and hepatology,2009,24(10):1631\u0026ndash;1638.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePark SB. Application of double-balloon enteroscopy for small bowel tumors. Clin Endosc. 2023 Jan;56(1):53\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYamamoto H, Kita H, Sunada K, et al. Clinical outcomes of double-balloon endoscopy for the diagnosis and treatment of small-intestinal diseases. Clin Gastroenterol Hepatol 2004;2:1010\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTsujikawa T, Saitoh Y, Andoh A, et al. Novel single-balloon enteroscopy for diagnosis and treatment of the small intestine: preliminary experiences. Endoscopy 2008;40:11\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDOMAGK D, MENSINK P, AKTAS H, et al. Single- vs. double-balloon enteroscopy in small-bowel diagnostics: a randomized multicenter trial.[J]. Endoscopy: Journal for Clinical Use Biopsy and Technique,2011,43(6):472\u0026ndash;476.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZaman A, Katon R M .Push enteroscopy for obscure gastrointestinal bleeding yields a high incidence of proximal lesions within reach of a standard endoscope[J].Gastrointestinal Endoscopy, 1998, 47(5):372\u0026ndash;376.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZuckerman GR, Prakash C, Askin MP, et al. AGA technical review on the evaluation and management of occult and obscure gastrointestinal bleeding. Gastroenterology. 2000 Jan;118(1):201\u0026thinsp;\u0026minus;\u0026thinsp;21.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCazzato IA, Cammarota G, Nista EC, Cesaro P, Sparano L, Bonomo V, Gasbarrini GB, Gasbarrini A. Diagnostic and therapeutic impact of double-balloon enteroscopy (DBE) in a series of 100 patients with suspected small bowel diseases. Dig Liver Dis. 2007 May;39(5):483-7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMOSCHLER O, MAY A, MULLER MK, et al. Complications in and performance of double-balloon enteroscopy (DBE): results from a large prospective DBE database in Germany.[J]. Endoscopy: Journal for Clinical Use Biopsy and Technique,2011,43(6):484\u0026ndash;489.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSato Y, Matsui T, Yano Y, et al. Long-term course of Crohn's disease in Japan: Incidence of complications, cumulative rate of initial surgery, and risk factors at diagnosis for initial surgery. J Gastroenterol Hepatol. 2015 Dec;30(12):1713-9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVan Assche G, Geboes K, Rutgeerts P. Medical therapy for Crohn's disease strictures. Inflamm Bowel Dis. 2004 Jan;10(1):55\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNavaneethan U, Lourdusamy V, Njei B, Shen B. Endoscopic balloon dilation in the management of strictures in Crohn's disease: a systematic review and meta-analysis of non-randomized trials. Surg Endosc. 2016 Dec;30(12):5434\u0026ndash;5443.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBettenworth D, Gustavsson A, Atreja A, et al. A Pooled Analysis of Efficacy, Safety, and Long-term Outcome of Endoscopic Balloon Dilation Therapy for Patients with Stricturing Crohn's Disease. Inflamm Bowel Dis. 2017 Jan;23(1):133\u0026ndash;142.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBamba S, Sakemi R, Fujii T, et al. A nationwide, multi-center, retrospective study of symptomatic small bowel stricture in patients with Crohn's disease. J Gastroenterol. 2020 Jun;55(6):615\u0026ndash;626.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSchottenfeld D, Beebe-Dimmer JL, Vigneau FD. The epidemiology and pathogenesis of neoplasia in the small intestine. Ann Epidemiol. 2009 Jan;19(1):58\u0026ndash;69.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZagorowicz ES, Pietrzak AM, Wronska E, et al. Small bowel tumors detected and missed during capsule endoscopy: single center experience. World J Gastroenterol. 2013 Dec 21;19(47):9043-8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eInoue Y, Hayashi M, Satou N, et al. Prognostic clinicopathological factors after curative resection of small bowel adenocarcinoma. J Gastrointest Cancer. 2012 Jun;43(2):272-8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlfagih A, Alrehaili M, Asmis T. Small Bowel Adenocarcinoma: 10-Year Experience in a Cancer Center-The Ottawa Hospital (TOH). Curr Oncol. 2022 Oct 5;29(10):7439\u0026ndash;7449.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhang C, Hong L, Zhang T, Sun P, Sun J, Zhou J, Wang L, Fan R, Wang Z, Cheng S, Zhong J. Clinical characteristics of small bowel tumors diagnosed by double-balloon endoscopy: Experience from a Chinese tertiary hospital. Turk J Gastroenterol. 2020 Jan;31(1):30\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSun B et al. The role of double\u0026thinsp;\u0026minus;\u0026thinsp;balloon enteroscopy in diagnosis and management of incomplete small\u0026thinsp;\u0026minus;\u0026thinsp;bowel obstruction. Endoscopy 2007; 39: 511\u0026ndash;515.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAKTAS H, DE RIDDER L, HARINGSMA J, et al. Complications of single-balloon enteroscopy: a prospective evaluation of 166 procedures.[J]. Endoscopy: Journal for Clinical Use Biopsy and Technique,2010,42(5):365\u0026ndash;368.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMANNO M, BARBERA C, DABIZZI E, et al. Safety of single-balloon enteroscopy: our experience of 72 procedures.[J]. Endoscopy: Journal for Clinical Use Biopsy and Technique,2010,42(9):773\u0026ndash;774.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMAY A. Balloon enteroscopy: single- and double-balloon enteroscopy.[J]. Gastrointestinal endoscopy clinics of North America,2009,19(3):349\u0026ndash;356.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eManno M, Barbera C, Bertani H, et al. Single balloon enteroscopy: Technical aspects and clinical applications. World J Gastrointest Endosc 2012; 4(2): 28\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHeine GD, Hadithi M, Groenen MJ, Kuipers EJ, Jacobs MA, Mulder CJ. Double-balloon enteroscopy: indications, diagnostic yield, and complications in a series of 275 patients with suspected small-bowel disease. Endoscopy. 2006 Jan;38(1):42\u0026thinsp;\u0026minus;\u0026thinsp;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eXin L, Liao Z, Jiang YP, et al. Indications, detectability, positive findings, total enteroscopy, and complications of diagnostic double balloon endoscopy: a systematic review of data over the first decade of use. Gastrointest Endosc 2011;74:563\u0026ndash;570.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMay A, Nachbar L, Pohl J, Ell C. Endoscopic interventions in the small bowel using double balloon enteroscopy: feasibility and limitations. Am J Gastroenterol. 2007 Mar;102(3):527\u0026thinsp;\u0026minus;\u0026thinsp;35.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDespott EJ, May A, Lazaridis N, et al. Double-balloon enteroscopy-facilitated cyanoacrylate-injection endotherapy of small-bowel varices: an international experience from 2 European tertiary centers (with videos). Gastrointest Endosc. 2019 Aug;90(2):302\u0026ndash;306.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1. The basic information of the patient.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"411\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003eParameters\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003eNumber\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 208px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003e1215\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 208px;\"\u003e\n \u003cp\u003eAge,year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003e41.67\u0026plusmn;15.75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 208px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003e801（65.9%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003e414（34.1%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eGeneral anesthesia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003e899（74.0%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003e316（26.0%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eDBE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003e297（24.4%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eSBE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003e918（75.6%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eYear of operation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eBefore 2020 (including 2020）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003e357（29.4%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eAfter 2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003e858（70.6%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eInspection method\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eoral \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003e210（17.3%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eanal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003e814（67.0%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eoral and anal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003e191（15.7%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eTransoral depth, m\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003e2.02\u0026plusmn;0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eTransanal depth, m\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003e1.16\u0026plusmn;1.65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eSymptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eabdominal pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003e499（41.1%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003efollow-up examination for CD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003e266（21.9%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003egastrointestinal bleeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003e199（16.4%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003ediarrhea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003e183（15.1%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eOthers (abdominal distension, vomiting, anemia, fever, etc.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003e68（5.5%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable 2. The result of the enteroscopy examination.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"411\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 244px;\"\u003e\n \u003cp\u003eResult of the enteroscopy\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003eN（n%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 244px;\"\u003e\n \u003cp\u003eCD or suspected CD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e555（45.7%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 244px;\"\u003e\n \u003cp\u003eSmall bowel ulcers and erosions (bowel tuberculosis, Behcet\u0026apos;s disease, nonspecific inflammation or undiagnosed)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e210（17.3%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 244px;\"\u003e\n \u003cp\u003eNegative（The result is normal or cannot explain the cause of the patient\u0026apos;s illness）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e162（13.3%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 244px;\"\u003e\n \u003cp\u003eTumor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e77（6.3%）\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 244px;\"\u003e\n \u003cp\u003eSmall bowel vascular malformations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e68（5.6%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 244px;\"\u003e\n \u003cp\u003eOthers (diverticula, foreign bodies, villous atrophy, allergic purpura, etc.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e143（11.8%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Small bowel diseases, single balloon enteroscopy, double balloon enteroscopy, enteroscopy","lastPublishedDoi":"10.21203/rs.3.rs-7584481/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7584481/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e The diagnosis of small bowel diseases remains challenging due to limited available diagnostic modalities. This study retrospectively analyzed clinical data from over 1,000 enteroscopy procedures performed over a period of more than 10 years to evaluate the diagnostic value of enteroscopy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This was a single-center, retrospective observational study. Patient demographic and clinical data were collected, including gender, age, examination date, anesthesia method, transoral or transanorectal approach, endoscopic insertion depth, examination findings, complications, and concordance with diagnoses obtained via small bowel CT or capsule endoscopy. Statistical analysis was performed using SPSS software.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e A total of 1,215 patients were included in the study, of whom 297 underwent double-balloon enteroscopy (DBE) and 918 underwent single-balloon enteroscopy (SBE). Among them, 210 underwent oral enteroscopy, 814 underwent anal enteroscopy, and 191 underwent combined oral and anal enteroscopy. The indications for enteroscopy varied, with the most common being abdominal pain (41.1%) and routine follow-up for Crohn's disease (CD) (21.9%). Endoscopic evaluation revealed 555 cases (45.7%) of CD or suspected CD, 210 cases (17.3%) of non-CD small bowel ulcers and erosions (including intestinal tuberculosis, Behcet's disease, nonspecific inflammation, or undiagnosed conditions), 162 cases (13.3%) with negative findings (normal results or findings not explaining the patient's symptoms), 77 cases (6.3%) of small bowel tumors, and 68 cases (5.6%) of small bowel vascular malformations. Three patients experienced gastrointestinal perforation either during the procedure or within 24 hours post-examination.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e Enteroscopy demonstrates significant diagnostic utility for conditions such as unexplained abdominal pain, gastrointestinal bleeding, celiac disease, and small intestinal tumors. Overall, the procedure is considered safe. DBE achieves greater insertion depth compared to SBE, and the oral approach allows for deeper intubation than the anal route. Patients under general anesthesia generally exhibit good tolerance.\u003c/p\u003e","manuscriptTitle":"10 years - Over 1000 cases - Summary and analysis of enteroscopy, a single-center retrospective study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-22 19:23:05","doi":"10.21203/rs.3.rs-7584481/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"98fd075e-af81-43e1-8329-31bc8260aa2d","owner":[],"postedDate":"October 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-31T09:23:55+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-22 19:23:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7584481","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7584481","identity":"rs-7584481","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}