Degree of concordance between double-balloon enteroscopy and capsule endoscopy in obscure gastrointestinal bleeding: a multicenter study

Marmo, Riccardo; Rotondano, G.; Casetti, T.; Manes, G; Chilovi, F.; Sprujevnik, Tatiana; Bianco, Maria Antonietta; Brancaccio, M.L.; Imbesi, V.; Benvenuti, Stefano; Pennazio, Marco

doi:10.1055/s-0029-1214896

Cited by 89 publications

(66 citation statements)

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“…CE-based diagnosis can be controversial because it depends only on gross findings. According to a multicenter study, the degree of concordance between CE and DBE is above 0.7 for vascular or inflammatory lesions, while it is only 0.46 for tumors [18]. In this study, biopsies were performed in three-fourths of the patients with small bowel tumors, and histopathological diagnosis was consistent with gross diagnosis in 72.9% of these cases.…”

Section: Discussionmentioning

confidence: 69%

Clinical Characteristics of Small Bowel Tumors Diagnosed by Double-Balloon Endoscopy: KASID Multi-Center Study

Lee

Choi

et al. 2011

Dig Dis Sci

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Background Small bowel tumors are relatively rare, and their confirmative diagnosis before surgery is not easy. Aims This study was performed to investigate the clinical characteristics of patients with small bowel tumors who received double-balloon enteroscopy (DBE). Secondary end points were to evaluate the usefulness and safety of DBE for the diagnosis of patients with suspected SB tumors derived from other previous procedures. Methods We retrospectively analyzed consecutive DBE examinations to explore the small intestine in eight university hospitals over a 5-year period. Results A total of 877 DBE examinations (per oral 487, per anal 390) were performed in 645 patients (405 males, mean age 48.2 years). Small bowel tumors were diagnosed in 112 patients (17.4%), of which 38 patients had benign polyps, 29 had gastrointestinal stromal tumors/leiomyomata, 18 had lymphomas, 14 had adenocarcinomas, five had metastatic or invasive cancers, five had lipomas, and three patients had cystic tumors. The main reasons for DBE among patients with small bowel tumors were obscure gastrointestinal bleeding (OGIB, 40.2%) followed by abnormal imaging study (25.2%). The concordance rate of diagnoses based on DBE with diagnoses based on small bowel follow-through, CT, and capsule endoscopy among patients with small bowel tumors was 68.9% (42/61), 75.3% (70/93), and 78.3% (18/23), respectively. Therapeutic plans were changed due to the DBE results in 64.2% of patients with small bowel tumors. Conclusions Approximately one-sixth of patients who received DBE had small bowel tumors, and the most common reason for DBE among patients with small bowel tumors was OGIB. DBE is a useful method for the 123Dig Dis Sci (2011) 56:2920-2927 DOI 10.1007/s10620-011-1839 confirmative diagnosis of small bowel tumors and has a good clinical impact on therapeutic plans and short-term clinical results.

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Section: Discussionmentioning

confidence: 69%

Clinical Characteristics of Small Bowel Tumors Diagnosed by Double-Balloon Endoscopy: KASID Multi-Center Study

Lee

Choi

et al. 2011

Dig Dis Sci

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“…In 2009, Fukumoto et al [18] reported finding an ileal diverticulum on DBE that was missed by VCE. Marmo et al [19] reported two missed jejunal diverticula that were later seen on subsequent DBE. Similarly, Arakawa et al [20] reported 2 cases of diverticulosis of the small bowel that were missed at previous VCE.…”

Section: Discussionmentioning

confidence: 99%

“…Angioectasia detected at DBE but not at VCE has also been described. Arakawa and Marmo each reported 2 VCE-negative DBE-positive cases [19,20] . None of these studies, however, assessed the test characteristics of VCE using DBE as the criterion standard.…”

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confidence: 99%

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

Tenembaum

Sison²,

Rubin³

2013

WJGE

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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.

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“…However, the introduction of CE and DBE has led to increased detection rates of small bowel tumors, which are identified in 7% to 17.4% patients with OGIB [7][8][9][10] . According to the report, small bowel tumors included GIST (28.6% to 32.1%), adenocarcinomas (20.5% to 25%), neuroendocrine tumor (14.3% to 15.2%), malignant lymphomas (10.7% to 14.3%), adipose tumors (8.9%), metastatic tumors (10.7%), and Kaposi sarcoma (3.6%) [11,12] .…”

Section: Discussionmentioning

confidence: 99%

Investigation of Undetected Small Bowel Tumors on Capsule Endoscopy

Maeda

Hiraishi

2015

Journal of Gastroenterology and Hepatology Research

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CONCLUSION:On CE, small bowel tumors showed atypical features, including a smooth submucosal bulge and the presence of ulcerated lesions and of blood, bowel residue, or feces, probably due to regional transit abnormalities related to the tumor. In such cases, it may be necessary to perform computed tomography, positron emission tomography/computed tomography, other examinations, or repeat CE after performing colonic irrigation to remove bowel residue. RESULTS:Of the 21 patients, CE accurately diagnosed tumors in 12 patients (57.1%). However, tumors were not detected in 9 patients because of a poor endoscopic view due to visual obstruction caused by blood, bowel residue, or feces (n=5; 23.8%), the presence of ulcerated lesions (n=3; 14.3%), or angioectasia (n=1; 4.8%). The sources of bleeding were considered to be ulcerated lesions or angioectasia. Of the 9 patients, 7 patients had tumors in the duodenum or the proximal jejunum. ORIGINAL ARTICLE Investigation of Undetected Small Bowel Tumors on Capsule EndoscopyMitsunori Maeda, Hideyuki Hiraishi Journal of Gastroenterology and Hepatology Researchlesions is a major issue, with the failure to detect neoplastic lesions having a major impact on prognosis. According to the literature, the rate of undetected neoplastic lesions in small-bowel CE is high (44.1% to 83.3%) [1][2][3][4] . Therefore, the aim of this study was to review CE findings in patients with small bowel tumors and analyze cases in which CE failed to detect tumors.

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Degree of concordance between double-balloon enteroscopy and capsule endoscopy in obscure gastrointestinal bleeding: a multicenter study

Cited by 89 publications

References 17 publications

Clinical Characteristics of Small Bowel Tumors Diagnosed by Double-Balloon Endoscopy: KASID Multi-Center Study

Clinical Characteristics of Small Bowel Tumors Diagnosed by Double-Balloon Endoscopy: KASID Multi-Center Study

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

Investigation of Undetected Small Bowel Tumors on Capsule Endoscopy

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