The Comparative Study of the Detection Rate Between Capsule Endoscopy and Double Balloon Enteroscopy in Our Four-Year Experience

Abstract

Background: There is no consensus on the relative accuracy of capsule endoscopy (CE) versus double balloon enteroscopy (DBE) to detect small bowel lesions. CE is less invasive, but DBE allows for examination of the entire small bowel, tissue sampling and therapeutic intervention. This retrospective study compares the detection rate of CE and DBE in our four-year experience. Adverse events, therapeutic interventions and duration of DBE were evaluated as secondary outcomes. Methods: We reviewed data of patients with obscure gastrointestinal bleeding and/or suspected small bowel lesions who were referred to our unit from December 2002 to November 2006. All patients required bowel preparation for both CE and DBE. After CE were done and reviewed, antegrade or retrograde or combined antegrade and retrograde DBE were performed with or without intervention. The data with a normal distribution were compared with the Student's paired t-test. Categorical data were compared with McNemar's test. Results: Forty five patients with obscure gastrointestinal bleeding [overt bleeding (n = 10), NSIAD use (n = 14), oral anticoagulant use (n = 5), mean Hb ± SD (g/dL):10.4 ± 1.7, number of red blood unit transfusion (median; range): 10; 0-100] and two patients with polyposis syndrome were studied with mean age of 63.9 years (range; 34-83) and 24 females. From forty seven CE and total of fifty five DBE procedures were conducted. CE detected positive findings 87.3% whereas DBE detected positive findings 85.5%, p = 0.5. The positive findings in each type of lesion was compared, angiodysplasia (CE 54.5% and DBE 60%, p = 0.3), erosions or ulcers (CE 14.5% and DBE 16.4%, p = 0.5), bleeding lesions (CE 40% and DBE 16.4%, p = 0.02), small bowel polyps and tumors (CE 80% and DBE 80%, p = 0.75). DBE provided the advantage of therapeutic intervention, argon plasma coagulation (n = 29), clipping (n = 2), both argon plasma coagulation and clipping (n = 2), polypectomies (n = 2), tattooing (n = 48) and biopsies (n = 9) were done. Mean duration of DBE was 179.8 minutes (range; 40-335 minutes) No major complication occurred with either examination. Two patients required resections of small bowel tumors. Conclusion: The overall detection rate of CE and DBE were similar, except in bleeding lesions that CE was superior. Therefore the patients with positive findings on CE should be followed by therapeutic DBE.