Balloon-assisted endoscopy: A Review and Delphi consensus on balloon-assisted-endoscopy

Introduction: Balloon-assisted endoscopy (BA) is established for diagnosis and therapy of lesions located in the small bowel. Moreover, BAE allows for ERCP in patients with altered gastrointestinal anatomy. Recent data has also highlighted the role of BAE for difficult colonoscopy and for improvement of adenoma detection rates.

Aims: An international, multidisciplinary, systematic search and evidence-based review of BAE was conducted and clear consensus recommendations for clinical use were provided.

Material and methods: We used a Delphi consensus process, with an 80% agreement threshold and used GRADE (Grading of Recommendations Assessment, Development and Evaluation) to categorize the quality of evidence and strength of recommendations. Experts from 9 different countries participated and the available literature was systematically searched. Based on the literature search, the scope of BAE was defined and statements were proposed.

Results: Clear consensus recommendations were given for diagnosis and treatment of obscure overt or obscure occult bleeding, diagnosis of Crohn's disease, malabsorption, diarrhea, tumors and mass lesions as well as for treatment of polyps, stenosis, strictures and removal of foreign bodies. Recommendations were made for potential contraindications, technical aspects of BAE and management of complications. In addition, BAE for ERCP and colonoscopy was reviewed. Clear recommendations were given for future training and for requirements for the histopathological diagnosis.

Conclusion: Key clinical recommendations on BAE were made in this large international consensus. In addition, strong recommendations for future research were proposed.