Bisher Sawaf, MD1, Mohammed Abu-Rumaileh, MD2, Sana Rabeeah, MD2, Maram Albandak, MD2, Yusuf Omar Hallak, MD2, Muhammed Elhadi, MD3, Wasef Sayeh, MD4, Muaz Alsabbagh, MD5, Sami Ghazaleh, MD6, Yaseen Alastal, MD6 1University of Toledo Medical Center, Toledo, OH; 2The University of Toledo, Toledo, OH; 3College of Medicine, Korea University, Seongbuk, Seoul-t'ukpyolsi, Republic of Korea; 4University of Toledo College of Medicine and Life Sciences, Toledo, OH; 5Detroit Medical Center/Wayne State University, Cleveland, OH; 6University of Toledo, Toledo, OH Introduction: Spiral enteroscopy (SE) and single-balloon enteroscopy (SBE) are established modalities for small bowel evaluation. Procedure time is a key metric influencing patient comfort, procedural efficiency, and endoscopy unit workflow. This systematic review and meta-analysis aimed to compare total procedure time between SE and SBE, with a particular focus on subgroup differences between manual SE and motorized SE. Methods: We conducted a comprehensive search of PubMed, Scopus, and the Cochrane Library on December 1, 2024, to identify comparative studies of SE (manual or motorized) and SBE. Primary outcome was total procedure time. Secondary outcomes included diagnostic yield, therapeutic yield, depth of maximal insertion (DMI), and adverse events. Effect sizes were pooled using a random-effects model, and subgroup analysis was performed to assess effect modification by SE type (manual vs. motorized). Results: Five studies involving 496 patients were included. The overall pooled analysis showed no statistically significant difference in procedure time between SE and SBE (mean difference [MD] = –22.85 minutes; 95% CI: –46.83 to 1.12; p = 0.06; I² = 95%) (Figure 1). However, subgroup analysis revealed a significant interaction by SE type. Manual SE showed no significant difference in procedure time compared to SBE (MD = –8.88 minutes; 95% CI: –32.76 to 15.00; p = 0.47), while motorized SE was associated with a significantly shorter procedure time (MD = –39.48 minutes; 95% CI: –56.58 to –22.39; p < 0.001). The test for subgroup differences confirmed a statistically significant effect modification (p < 0.001), indicating that motorized SE substantially improves procedural efficiency compared to both manual SE and SBE (Figure 2). Discussion: Although overall procedure time did not differ significantly between SE and SBE, subgroup analysis demonstrated that motorized SE is significantly faster than both manual SE and SBE. This suggests that motorized SE offers a notable procedural efficiency advantage, which may translate into improved workflow and patient throughput. These findings warrant confirmation in larger, multicenter randomized trials and cost-effectiveness evaluations.
Figure: Figure 1: Forest plot comparing total procedure time between spiral enteroscopy and single-balloon enteroscopy across all studies.
Figure: Figure 2: Subgroup analysis showing procedure time differences between manual and motorized spiral enteroscopy versus single-balloon enteroscopy.
Disclosures: Bisher Sawaf indicated no relevant financial relationships. Mohammed Abu-Rumaileh indicated no relevant financial relationships. Sana Rabeeah indicated no relevant financial relationships. Maram Albandak indicated no relevant financial relationships. Yusuf Omar Hallak indicated no relevant financial relationships. Muhammed Elhadi indicated no relevant financial relationships. Wasef Sayeh indicated no relevant financial relationships. Muaz Alsabbagh indicated no relevant financial relationships. Sami Ghazaleh indicated no relevant financial relationships. Yaseen Alastal indicated no relevant financial relationships.
Bisher Sawaf, MD1, Mohammed Abu-Rumaileh, MD2, Sana Rabeeah, MD2, Maram Albandak, MD2, Yusuf Omar Hallak, MD2, Muhammed Elhadi, MD3, Wasef Sayeh, MD4, Muaz Alsabbagh, MD5, Sami Ghazaleh, MD6, Yaseen Alastal, MD6. P1383 - Procedure Time Comparison of Spiral vs. Single-Balloon Enteroscopy: A Systematic Review and Meta-Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
