Different roles of capsule endoscopy and double-balloon enteroscopy in obscure small intestinal diseases

Abstract

AIM:To compare the roles of capsule endoscopy (CE) and double-balloon enteroscopy (DBE) in the diagnosis of obscure small bowel diseases. December 2014, 88 patients were included in this study; the patients had undergone gastroscopy, colonoscopy, radiological small intestinal barium meal, abdominal computed tomography or magnetic resonance imaging scan and mesenteric angiography, but their diagnoses were still unclear. The patients with gastrointestinal obstructions, fistulas, strictures, or cardiac pacemakers, as well as pregnant women, and individuals who could not accept the capsule-retention or capsule-removal surgery were excluded. Patients with heart, lung and other vital organ failure diseases were also excluded. Everyone involved in this study had undergone CE and DBE. The results were divided into: (1) the definite diagnosis (the diagnosis was confirmed at least by one of the biopsy, surgery, pathology or the drug treatment effects with follow-up for at least 3 mo); (2) the possible diagnosis (a possible diagnosis was suggested by CE or DBE, but not confirmed by the biopsy, surgery or follow-up drug treatment effects); and (3) the unclear diagnosis (no exact causes were provided by CE and DBE for the disease). The detection rate and the diagnostic yield of the two methods were compared. in the etiologies between CE and DBE was estimated, and the different possible etiologies caused by the age groups were also investigated. METHODS: From June 2009 toRESULTS: CE exhibited a better trend than DBE for diagnosing scattered small ulcers (P = 0.242, Fisher' s test), and small vascular malformations (χ 2 = 1.810, P = 0.179, Pearson χ 2 test), but with no significant differences, possible due to few cases. However, DBE was better than CE for larger tumors (P = 0.018, Fisher's test) and for diverticular lesions with bleeding ulcers (P = 0.005, Fisher's test). All three hemangioma cases diagnosed by DBE in this study (including sponge hemangioma, venous hemangioma, and hemangioma with hamartoma lesions) were all confirmed by biopsy. Two parasite cases were found by CE, but were negative by DBE. This study revealed no obvious differences in the detection rates (DR) of CE (60.0%, 53/88) and DBE (59.1%, 52/88). However, the etiological diagnostic yield (DY) difference was apparent. The CE diagnostic yield was 42.0% (37/88), and the DBE diagnostic yield was 51.1% (45/88). Furthermore, there were differences among the age groups (χ 2 = 22.146, P = 0.008, Kruskal Wallis Test). Small intestinal cancer (5/6 cases), vascular malformations (22/29 cases), and active bleeding (3/4 cases) appeared more commonly in the patients over 50 years old, but diverticula with bleeding ulcers were usually found in the 15-25-year group (4/7cases). The over-25-year group accounted for the stromal tumors (10/12 cases).CONCLUSION: CE and DBE each have their own advantages and disadvantages. The appropriate choice depends on the patient's age, tolerance, and clinical manifestations. Sometimes CE followed by DBE is necessary. Core t...

Analysis of Non-Small Bowel Lesions Detected by Capsule Endoscopy in Patients with Potential Small Bowel Bleeding

“…VCE is a simple and noninvasive imaging technique for the examination of small bowel. Previous studies showed that VCE is able to show the source of bleeding in the small intestine in patients with potential small bowel bleeding [ 4 , 15 – 20 ]. In patients with potential small bowel bleeding and in whom upper and lower GI system endoscopies cannot define the source of bleeding next step in the diagnostic algorithm is proposed to be VCE [ 1 – 3 ].…”

Small bowel malignant tumor: a diagnostic dilemma, a case report and literature review

“…The definite diagnostic yield of CE is only 20-30%, while DBE accounts for 60-70% of the diagnostic yield for intestinal diseases. 17 However, CE is suitable for diagnosing scattered, small and multiple lesions, as well as active bleeding; it is convenient, noninvasive, secure and comfortable. In contrast, the DBE procedure is uncomfortable, less tolerated and difficult to complete; these factors influence its diagnosis.…”

Misdiagnosis of multiple synchronous small bowel adenocarcinomas as intestinal tuberculosis: a case report

“…The remainder of the small bowel cannot be accessed without the use of video capsule endoscopy (CE) or double balloon enteroscopy (DBE). The definitive diagnostic yield of CE is as low as 20-30%, whilst DBE accounts for 60-70% of the diagnostic yield for intestinal disease [13]. However, CE is suitable for diagnosing scattered, small, or multiple lesions, in addition to active bleeding.…”