Double-balloon enteroscopy in Ireland in the capsule endoscopy era

Holleran, Grainne; Hall, Barry; Alhinai, M.; Zaheer, Abdul; Leen, Ronan; Alakkari, Alaa; Mahmud, Nasir; McNamara, Deirdre

doi:10.1007/s11845-014-1097-0

Cited by 4 publications

(1 citation statement)

References 24 publications

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“…It is highly invasive: procedures are more prolonged than conventional endoscopy and have a reported major complication rate of up to 4.3% [65]. Over the last few years the published literature has recommended that SBCE and BAE are more efficacious when used in synergy [66,67,68]. SBCE allows complete visualisation of the small intestine in over 90% of cases, which if positive then directs the approach of BAE, reducing the need for bi-directional BAE [69].…”

Section: Diagnosis Of Small Bowel CDmentioning

confidence: 99%

Small Bowel Crohn's Disease: An Emerging Disease Phenotype?

Hall¹,

Holleran²,

McNamara³

2014

Dig Dis

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An increasing understanding of the pathogenesis of Crohn's disease (CD), coupled with improvements in therapeutic options, has promoted the concept of stratifying patients with CD into distinct disease phenotypes according to risk. Small bowel CD, due to the numerous non-specific potential symptoms and the anatomical location of the disease, is a particularly difficult phenotype to identify. The fact that the majority of de novo strictures occur in the ileum/ileo-colonic region ensures that recognition of small bowel involvement is essential. Certainly, it is becoming increasingly recognised due to improvements in imaging and endoscopic techniques. Both CT and MR enterography appear capable of accurately diagnosing small bowel CD. Furthermore, the development of capsule endoscopy and balloon-assisted enteroscopy allow direct visualisation of the small bowel. Limited data to date would suggest that small bowel CD is a difficult entity to treat even in the current era of the ever-expanding field of biological therapies. Further long-term follow-up studies are necessary using both small bowel capsule endoscopy and cross-sectional imaging to truly assess, firstly, whether small bowel CD is more resistant to treatment and, secondly, whether it has an effect over time in terms of complications. In the future, serological and genetic tests, coupled with the aforementioned investigations, will permit early diagnosis and early treatment of small bowel CD.

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Section: Diagnosis Of Small Bowel CDmentioning

confidence: 99%

Small Bowel Crohn's Disease: An Emerging Disease Phenotype?

Hall¹,

Holleran²,

McNamara³

2014

Dig Dis

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Enteroscopy and radiology for the management of celiac disease complications: Time for a pragmatic roadmap

Branchi

Locatelli

Tomba

et al. 2016

Digestive and Liver Disease

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Video capsule endoscopy vs double-balloon enteroscopy in the diagnosis of small bowel bleeding: A systematic review and meta-analysis

Brito¹,

Ribeiro²,

Bernardo³

et al. 2018

WJGE

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AIMTo compare the diagnostic accuracy of video capsule endoscopy (VCE) and double-balloon enteroscopy (DBE) in cases of obscure gastrointestinal bleeding (OGIB) of vascular origin.METHODSMEDLINE (via PubMed), LILACS (via BVS) and Cochrane/CENTRAL virtual databases were searched for studies dated before 2017. We identified prospective and retrospective studies, including observational, cohort, single-blinded and multicenter studies, comparing VCE and DBE for the diagnosis of OGIB, and data of all the vascular sources of bleeding were collected. All patients were subjected to the same gold standard method. Relevant data were then extracted from each included study using a standardized extraction form. We calculated study variables (sensitivity, specificity, prevalence, positive and negative predictive values and accuracy) and performed a meta-analysis using Meta-Disc software.RESULTSIn the per-patient analysis, 17 studies (1477 lesions) were included. We identified 3150 exams (1722 VCE and 1428 DBE) in 2043 patients and identified 2248 sources of bleeding, 1467 of which were from vascular lesions. Of these lesions, 864 (58.5%) were diagnosed by VCE, and 613 (41.5%) were diagnosed by DBE. The pretest probability for bleeding of vascular origin was 54.34%. The sensitivity of DBE was 84% (95%CI: 0.82-0.86; heterogeneity: 78.00%), and the specificity was 92% (95%CI: 0.89-0.94; heterogeneity: 92.0%). For DBE, the positive likelihood ratio was 11.29 (95%CI: 4.83-26.40; heterogeneity: 91.6%), and the negative likelihood ratio was 0.20 (95%CI: 0.15-0.27; heterogeneity: 67.3%). Performing DBE after CE increased the diagnostic yield of vascular lesion by 7%, from 83% to 90%.CONCLUSIONThe diagnostic accuracy of detecting small bowel bleeding from a vascular source is increased with the use of an isolated video capsule endoscope compared with isolated DBE. However, concomitant use increases the detection rate of the bleeding source.

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Double-balloon enteroscopy in Ireland in the capsule endoscopy era

Abstract: SBCE as a screening tool prior to DBE is extremely valuable and increases the diagnostic yield considerably as a consequence of a high negative predictive value.

Cited by 4 publications

References 24 publications

Small Bowel Crohn's Disease: An Emerging Disease Phenotype?

Small Bowel Crohn's Disease: An Emerging Disease Phenotype?

Enteroscopy and radiology for the management of celiac disease complications: Time for a pragmatic roadmap

Video capsule endoscopy vs double-balloon enteroscopy in the diagnosis of small bowel bleeding: A systematic review and meta-analysis

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