Accuracy of community based video capsule endoscopy in patients undergoing follow up double balloon enteroscopy

Abstract

AIM:To determine the test characteristics of community based video capsule endoscopy (VCE) in patients undergoing sequential VCE and double balloon enteroscopy (DBE). METHODS:Eighty-nine patients (34 females, 55 males, mean age 66) who underwent both VCE and DBE from 2008-2010 were retrospectively reviewed. Lesions detected at VCE were categorized. Capsule directed DBE followed and included 44 antegrade, 11 retrograde and 34 combined antegrade and retrograde procedures. Lesions detected were compared utilizing the McNemar's test. RESULTS:Angioectasia detection with VCE was 25% and with DBE 35% (P < 0.03) with a calculated sensitivity and specificity of 58% and 93% respectively. Polyps were detected by VCE in 22% and in DBE 20%, (P = 0.6), with a sensitivity and specificity for VCE of 61% and 87%. Small bowel diverticula were only seen in 1% of VCE but in 12% of DBE patients (P < 0.002) with a calculated sensitivity and specificity of VCE of 9% and 100%.CONCLUSION: VCE would be moderately sensitive and specific overall with considerable variation by lesion. Furthermore, VCE cannot be relied upon to diagnose small bowel diverticula.© 2013 Baishideng. All rights reserved.Key words: Video capsule endoscopy; Double balloon enteroscopy; Angioectasia; Diverticulosis; Obscure gastrointestinal bleeding Core tip: Advances in endoscopic technology have revolutionized the evaluation of small intestinal disorders. Non-invasive imaging utilizing video capsule endoscopy (VCE) offers the potential to safely visualize the entire small bowel with a high diagnostic yield. It is limited by a lack of therapeutic ability, imprecise localization, failure to reach the colon in all cases and inconsistent visualization of the entire small bowel. Deep enteroscopy, utilizing double balloon enteroscopy (DBE), enables diagnostic and therapeutic endoscopy of the small bowel. Although total enteroscopy can be accomplished, it typically requires antegrade and retrograde approaches. In most clinical situations, VCE is performed initially. By using DBE as the criterion (gold) standard, the sensitivity and specificity of community based VCE can be assessed for individual lesions, offering a more informative comparison than diagnostic yield.

Double-Balloon Endoscopy in Overt and Occult Small Bowel Bleeding: Results, Complications, and Correlation with Prior Videocapsule Endoscopy in a Tertiary Referral Center

“…The DBE detection rate of 64% was similar to that of other studies (43%–69%) [ 13 - 18 ]. A recently published meta-analysis showed a 56% diagnostic yield in DBE [ 5 ].…”

Small Bowel Capsule Endoscopy

“…These data confirmed results from an earlier retrospective study [48] in which CE was compared with a composite reference standard, taking into account both further diagnostic examinations and the follow-up. Moreover, in a more recent paper, Tenembaum et al [67] compared CE with DAE combining oral and anal approach, according to the type of the lesion identified. These authors found that although CE and DAE yielded similar results, CE had an excellent accuracy profile for masses/ tumours (sensitivity and specificity: 100 %), an intermediate performance for vascular and inflammatory lesions (sensitivity: 58 and 50 % respectively; specificity: 93 and 98 % respectively) and a disappointing accuracy for small bowel diverticulae (sensitivity: 9 %; specificity: 100 %).…”

“…Small bowel diverticulae are frequently overlooked in CE due to lack of insufflation [67] (Fig. 3.15).…”