A Prospective Study on Evaluating the Diagnostic Yield of Video Capsule Endoscopy Followed by Directed Double-Balloon Enteroscopy in Patients with Obscure Gastrointestinal Bleeding

Li, Xiaobo; Dai, Jun; Lü, Hong; Gao, Yun‐Jie; Chen, Huimin; Ge, Zhi‐Zheng

doi:10.1007/s10620-009-0911-4

Cited by 36 publications

(27 citation statements)

References 27 publications

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“…CE enables direct visualisation of the small bowel mucosa and has a high sensitivity for detecting flat lesions, such as angiodysplasias, ulcers and arteriovenous malformations which are not easily detectable on radiological modalities [15] . The reported diagnostic yield in literature ranges from 58.4% to 86.8% [9,14,[16][17][18][19][20][21] . The wide range is attributable to different definitions of a positive finding on CE.…”

Section: Capsule Endoscopymentioning

confidence: 99%

“…The targeted approach is also useful in confirming indeterminate findings from CE. Hence, it is strongly suggested that CE is the initial screening modality in OGIB and that these two investigations should be viewed as complementary [20,64] . Not surprisingly, when compared with PE, a controlled prospective trial on patients with suspected small bowel bleeding, confirmed that anterograde DBE is significantly superior to PE in regards to the detection of pathological lesions (63% vs 44%) and the length of small bowel visualised (230 cm vs 80 cm) [65] .…”

Section: Capsule Endoscopymentioning

confidence: 99%

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Evaluation and outcomes of patients with obscure gastrointestinal bleeding

Santhakumar

Liu

2014

WJGP

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Core tip: This article examines the role of current diagnostic modalities for the investigation of obscure gastrointestinal bleeding (OGIB) and outcomes in patients undergoing these investigations. Capsule endoscopy and double balloon enteroscopy remain the cornerstone of diagnostic and therapeutic management. The diagnostic and therapeutic capabilities of certain modalities are influenced by the nature of bleeding in OGIB. Longterm outcome data in patients with OGIB is limited but is most promising for capsule endoscopy.Santhakumar C, Liu K. Evaluation and outcomes of patients with obscure gastrointestinal bleeding. World J Gastrointest Pathophysiol 2014; 5(4

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Section: Capsule Endoscopymentioning

confidence: 99%

Section: Capsule Endoscopymentioning

confidence: 99%

Evaluation and outcomes of patients with obscure gastrointestinal bleeding

Santhakumar

Liu

2014

WJGP

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“…Two recent meta-analyses of studies comparing VCE and DBE have demonstrated comparable diagnostic yields [1,2] . Few studies, however, compared the individual abnormalities detected at VCE with those subsequently confirmed at DBE [9] . We propose to evaluate the test characteristics of VCE for each type of lesion by comparing the results of community based VCE to the findings at follow up DBE for each patient.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of community based video capsule endoscopy in patients undergoing follow up double balloon enteroscopy

Tenembaum

Sison²,

Rubin³

2013

WJGE

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AIM:To determine the test characteristics of community based video capsule endoscopy (VCE) in patients undergoing sequential VCE and double balloon enteroscopy (DBE). METHODS:Eighty-nine patients (34 females, 55 males, mean age 66) who underwent both VCE and DBE from 2008-2010 were retrospectively reviewed. Lesions detected at VCE were categorized. Capsule directed DBE followed and included 44 antegrade, 11 retrograde and 34 combined antegrade and retrograde procedures. Lesions detected were compared utilizing the McNemar's test. RESULTS:Angioectasia detection with VCE was 25% and with DBE 35% (P < 0.03) with a calculated sensitivity and specificity of 58% and 93% respectively. Polyps were detected by VCE in 22% and in DBE 20%, (P = 0.6), with a sensitivity and specificity for VCE of 61% and 87%. Small bowel diverticula were only seen in 1% of VCE but in 12% of DBE patients (P < 0.002) with a calculated sensitivity and specificity of VCE of 9% and 100%.CONCLUSION: VCE would be moderately sensitive and specific overall with considerable variation by lesion. Furthermore, VCE cannot be relied upon to diagnose small bowel diverticula.© 2013 Baishideng. All rights reserved.Key words: Video capsule endoscopy; Double balloon enteroscopy; Angioectasia; Diverticulosis; Obscure gastrointestinal bleeding Core tip: Advances in endoscopic technology have revolutionized the evaluation of small intestinal disorders. Non-invasive imaging utilizing video capsule endoscopy (VCE) offers the potential to safely visualize the entire small bowel with a high diagnostic yield. It is limited by a lack of therapeutic ability, imprecise localization, failure to reach the colon in all cases and inconsistent visualization of the entire small bowel. Deep enteroscopy, utilizing double balloon enteroscopy (DBE), enables diagnostic and therapeutic endoscopy of the small bowel. Although total enteroscopy can be accomplished, it typically requires antegrade and retrograde approaches. In most clinical situations, VCE is performed initially. By using DBE as the criterion (gold) standard, the sensitivity and specificity of community based VCE can be assessed for individual lesions, offering a more informative comparison than diagnostic yield.

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“…Patients with positive VCE necessitate endoscopic interventions for effective treatment and DBE has been shown to provide significant aid in patients with small bowel lesions or those who are at high risk for re-bleeding despite a non-diagnostic VCE (25,35). In a meta-analysis of seven studies, the diagnostic yield for DBE after negative VCE for OGIB was 27.5% (95% CI, 16.7-37.8%) (12), while VCE followed by DBE has been established as an effective strategy for investigating OGIB and particularly to confirm a negative VCE examination (53). Hence, DBE does not compete to VCE; it has a rather complementary role.…”

Section: Impact On Subsequent Therapeutic Strategies and Clinical Outmentioning

confidence: 99%

Long-term effects of video capsule endoscopy in the management of obscure gastrointestinal bleeding

et al. 2017

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Obscure gastrointestinal bleeding (OGIB) accounts for approximately 5% of all gastrointestinal (GI) hemorrhages. It usually arises from a small bowel lesion beyond the reach of conventional endoscopy including esophagogastroduodenoscopy and colonoscopy. Video capsule endoscopy (VCE) revolutionized the evaluation of OGIB patients since it allows reliable and noninvasive visualization of the small bowel mucosal surface. Since 2001, VCE has evolved into an efficient technology integrated in clinical practice. It is the cornerstone in the algorithm of OGIB investigation given its high diagnostic yield, which compares favorably to that of double-balloon enteroscopy (DBE). In terms of outcomes, a positive index VCE examination usually correlates to a high re-bleeding rate, while a negative one provides adequate evidence of low re-bleeding risk, suggesting a wait and watch approach in this subset of patients. Additionally, a variety of factors has been acknowledged as significant predictors of re-bleeding episodes. While research data regarding immediate endoscopic findings have matured, data concerning the clinical utility of VCE in patients with OGIB on the long-term remain sparse. This manuscript reviews the current literature, aiming to highlight the role of VCE in the long-term management of OGIB.

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A Prospective Study on Evaluating the Diagnostic Yield of Video Capsule Endoscopy Followed by Directed Double-Balloon Enteroscopy in Patients with Obscure Gastrointestinal Bleeding

Abstract: Capsule endoscopy followed by directed double-balloon enteroscopy is a good strategy for investigating the causes of obscure GI bleeding and especially in confirming indeterminate and negative findings from VCE.

Cited by 36 publications

References 27 publications

Evaluation and outcomes of patients with obscure gastrointestinal bleeding

Evaluation and outcomes of patients with obscure gastrointestinal bleeding

Accuracy of community based video capsule endoscopy in patients undergoing follow up double balloon enteroscopy

Long-term effects of video capsule endoscopy in the management of obscure gastrointestinal bleeding

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