A Comparison of Diagnostic Yield and Degree of Agreement Between Capsule Endoscopy and Double Balloon Enteroscopy in Evaluating Small Intestinal Disorders

Abstract

Purpose: The aim of our study is to compare the diagnostic yield and degree of agreement between Capsule Endoscopy (CE) and Double Balloon Enteroscopy (DBE) in evaluating small bowel disorders. Methods: Following IRB approval, we undertook a retrospective chart review of 119 consecutive patients who underwent both CE and DBE from January 2005 to August 2006. The indications for DBE were obscure overt GI bleeding (42%), obscure occult GI bleeding (37%), suspected mass (10%), mucosal changes (10%) and retained capsule (1%). The degree of agreement between CE and DBE was assessed using Cohen's kappa statistics. Results: 55 (46%) males and 64 (54%) females underwent both DBE and CE. The mean age was 62 ± 19.8 years (range 17–100 years). CE was abnormal in 74 (62%) patients compared to DBE which revealed abnormalities in 80 (67%) patients. For agreement between the two tests, there was a trend towards significance (kappa value = 0.28, P= .06). Among 45 patients with negative CE, DBE revealed small bowel pathology in 24 (53.3%) patients whereas in 37 patients with negative DBE, CE suspected a small bowel pathology in 18 (48%) patients. DBE revealed small intestinal diverticuli in 7 patients (5.9%) whereas CE failed to show them. Discussion: Our study confirms that CE and DBE supplement each other in studying small bowel disorders, in particular obscure GI bleeding. Although CE and DBE have comparable overall diagnostic yield, DBE detects more small bowel diverticuli and normal variants. While CE appears to have higher diagnostic yield in detecting ulcers, masses and active bleeding, it may be falsely positive in some of these patients where DBE clarifies the diagnosis by accurately identifying the normal variants. DBE also demonstrates the underlying pathology in patients with active bleeding on CE. Conclusion: The overall diagnostic yield of DBE is comparable with CE in detecting small bowel pathology. There is a trend towards significance for agreement between CE and DBE and a higher sample size will likely achieve the statistical significance.Table