S2177 Procedure Time Comparison of Spiral vs Single-Balloon Enteroscopy: A Systematic Review and Meta-Analysis

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%). 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. Conclusion: 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.