Double-Balloon Enteroscopy (DBE) and Capsule Endoscopy (CE) Have a Comparable Diagnostic Yield in Patients with Suspected Small Bowel Disease: A Meta-Analysis

Abstract

Background: Endoscopic small bowel imaging has been significantly advanced by the introduction of both CE and DBE. It is not known for certain which modality has the best diagnostic yield. Aim: To compare the diagnostic yield of CE with that of DBE in patients with suspected small bowel disease using meta-analysis. Methods: A recursive literature search of studies comparing the yield of CE to other modalities in patients with suspected small bowel disease was performed. Data on the diagnostic yield in CE and DBE were extracted, pooled and analyzed using RevMan 4.2.9 software; heterogeneity was tested by the chi2 method and a p-value of <0.1 was considered significant heterogeneity. Weighted incremental yield (IYW) (yield of CE - yield of DBE) of CE over DBE and 95% confidence intervals (CI) for the pooled data was calculated using a fixed effect model (FEM) for analyses without and a random effect model (REM) for analyses with significant heterogeneity. Results: Eleven studies compared the diagnostic yield of CE with DBE. The pooled overall yield for CE and DBE was 60% (n = 393) and 57% (n = 356), respectively (IYW = 3%; CI -3-10%; P = 0.34; FEM). Eight studies reported the yield of vascular findings on CE and DBE. The pooled yield for CE and DBE for vascular findings was 24% (n = 313) and 25% (n = 306), respectively (IYW = −3%; CI -14-8%; P = 0.62; REM). Seven studies reported the yield of inflammatory findings (erosions, ulcers and strictures) on CE and DBE. The pooled yield for CE and DBE was 18% (n = 285) and 16% (n = 278), respectively (IYW = 0%; CI -6-6%; P = 0.93; FEM). Seven studies reported the yield of polyps/tumors on CE and DBE. The pooled yield for CE and DBE was 7% (n = 285) and 12% (n = 278), respectively (IYW = −3%; CI -8-2%; P = 0.25; FEM). Conclusions: In patients with suspected small bowel disease, DBE had a comparable yield to CE for the diagnosis of small bowel pathology. Because the capsule is non-invasive, these results would suggest that CE is the initial diagnostic test of choice in most patients with suspected small bowel disease. In those patients with a positive finding on CE or a high suspicion of a small bowel lesion despite a negative CE, DBE would be indicated for further evaluation due to its diagnostic and therapeutic capabilities.