Diagnostic yield of video capsule endoscopy vs simple balloon enteroscopy in small intestinal disorders: A systematic review.

Abstract

Background: Small-bowel disorders, including obscure gastrointestinal bleeding (OGIB), Crohn's disease, and tumors, require accurate diagnostic approaches for effective treatment. Video capsule endoscopy (VCE) and simple balloon enteroscopy (SBE) are widely used; however, each modality has limitations, particularly regarding therapeutic intervention and diagnostic yield.

Aim: To evaluate diagnostic yields of various modalities for small bowel bleeding, analyze factors affecting heterogeneity, and improve understanding of clinical outcomes associated with different diagnostic approaches.

Methods: A comprehensive search of four databases (PubMed, Embase, Cochrane Library, and Scopus) revealed over 600 citations related to the use of capsule endoscopy and balloon enteroscopy for diagnosing small intestine disorders with wall thickening. Based on predetermined eligibility criteria, seven moderate-to-high-quality retrospective studies were analyzed to evaluate the diagnostic performance of VCE and SBE in patients with small bowel disorders. Quality Assessment of Diagnostic Accuracy Studies was applied to evaluate the risk of bias and overall methodological quality.

Results: Analysis of seven moderate-to-high-quality retrospective studies revealed comparable overall detection rates for small bowel lesions between VCE and SBE. VCE demonstrated superior performance in detecting vascular lesions. Conversely, SBE exhibited a higher efficacy in detecting ulcerative lesions. The overall diagnostic yield varied across studies, with VCE showing a range of 32%-83% for small bowel bleeding, whereas SBE demonstrated a higher overall detection rate of 69.7% compared to 57.6% for VCE (P < 0.05). Notably, SBE showed superior performance in diagnosing Crohn's disease, with a detection rate of 35%, compared to 11.3% for VCE (P < 0.001). The diagnostic concordance between VCE and SBE was influenced by the lesion type. Strong agreement was observed for inflammatory lesions (κ = 0.82, 95%CI: 0.75-0.89), whereas moderate agreement was noted for tumors (κ = 0.61, 95%CI: 0.52-0.70) and angiectasias (κ = 0.58, 95%CI: 0.49-0.67). SBE demonstrated significant advantages in therapeutic interventions, particularly in overt bleeding. Patient tolerability was generally higher for VCE, with a completion rate of 95% (95%CI: 92%-98%), compared to 85% for SBE (95%CI: 80%-90%). However, the capsule retention rate for VCE was 1.4% (95%CI: 0.8%-2.0%), necessitating subsequent intervention.

Conclusion: VCE and SBE are complementary techniques for evaluating small intestinal disorders. Although VCE remains the initial test of choice for patients with stable OGIB, SBE should be considered in patients requiring therapeutic intervention. Thus, combining both modalities enhances diagnostic accuracy and patient management.