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2015 ; 21
(23
): 7297-304
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Different roles of capsule endoscopy and double-balloon enteroscopy in obscure
small intestinal diseases
#MMPMID26109818
Zhang ZH
; Qiu CH
; Li Y
World J Gastroenterol
2015[Jun]; 21
(23
): 7297-304
PMID26109818
show ga
AIM: To compare the roles of capsule endoscopy (CE) and double-balloon
enteroscopy (DBE) in the diagnosis of obscure small bowel diseases. METHODS: From
June 2009 to 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. The difference in the etiologies between CE and DBE was estimated, and
the different possible etiologies caused by the age groups were also
investigated. RESULTS: CE exhibited a better trend than DBE for diagnosing
scattered small ulcers (P = 0.242, Fisher's test), and small vascular
malformations (?(2) = 1.810, P = 0.179, Pearson ?(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 (?(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.
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