Single- vs. double-balloon enteroscopy in small-bowel diagnostics: a randomized multicenter trial

Domagk, Dirk; Mensink, Peter; Aktaş, Hüseyin; Lenz, Philipp; Meister, Tobias; Luegering, Andreas; Ullerich, Hansjoerg; Aabakken, Lars; Heinecke, Achim; Domschke, Wolfram; Kuipers, Ernst J.; Bretthauer, Michael

doi:10.1055/s-0030-1256247

Cited by 167 publications

(119 citation statements)

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“…In total 44 patients underwent antegrade DBE, 11 retrograde DBE and 34 underwent both. Sixteen of the 34 had complete enteroscopy [5,6] . In patients with obscure gastrointestinal bleeding (OGIB) and negative VCE exams, DBE was guided by the patient's history.…”

Section: Patientsmentioning

confidence: 99%

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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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Section: Patientsmentioning

confidence: 99%

“…Although total enteroscopy can be accomplished, it typically requires antegrade and retrograde approaches. The rate of total enteroscopy varies between 11%-66% [5,6] . In most clinical situations, VCE is performed initially [3] .…”

Section: Introductionmentioning

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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“…These results were confirmed by a Japanese prospective single-center trial comparing the DBE Fujinon device with the SBE Olympus device, demonstrating a complete enteroscopy rate for DBE of 57% and 0% for SBE [36]. In contrast, the third multicenter comparing trial found no differences between the two systems, but due to several reasons the results and/or conclusions have to be read with caution [37,38]. …”

Section: Comparison Of the Different Flexible Enteroscopy Techniquesmentioning

confidence: 86%

“…There are three published prospective randomized studies comparing DBE and SBE [35,36,37]. One prospective multicenter trial comparing the DBE and SBE techniques using the Fujinon device showed that the DBE technique was clearly superior to the SBE technique [35].…”

Section: Comparison Of the Different Flexible Enteroscopy Techniquesmentioning

confidence: 99%

Modern Imaging Techniques: Which - When - Why?

May¹

2013

Dig Dis

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Within the last decade, the technological development improved the diagnostic work-up of small bowel diseases. In addition to abdominal ultrasound and radiological methods, the importance of endoscopy is increasing. Nowadays, five nonsurgical flexible endoscopy techniques are available for small bowel endoscopy: push enteroscopy and balloon-guided enteroscopy for evaluation of the proximal small bowel, balloon-assisted enteroscopy using two balloons (double-balloon enteroscopy) or one balloon (single-balloon enteroscopy), and spiral enteroscopy for evaluation of the deep small bowel. Intraoperative enteroscopy has become a reserve method.

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“…According to previous research, CE accounts for 56%-70% of small intestinal bleeding disorders [1] , whereas the definite diagnostic yield is only 20%-30% [2,3] . DBE accounts for 60%-70% of the diagnostic yield for intestinal diseases [4,5] . Therefore, there are still flaws in the diagnoses of obscure small intestinal diseases.…”

Section: Discussionmentioning

confidence: 99%

Different roles of capsule endoscopy and double-balloon enteroscopy in obscure small intestinal diseases

Zhang¹,

Chun-hua²,

Li³

2015

WJG

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AIM:To compare the roles of capsule endoscopy (CE) and double-balloon enteroscopy (DBE) in the diagnosis of obscure small bowel diseases. December 2014, 88 patients were included in this study; the patients had undergone gastroscopy, colonoscopy, radiological small intestinal barium meal, abdominal computed tomography or magnetic resonance imaging scan and mesenteric angiography, but their diagnoses were still unclear. The patients with gastrointestinal obstructions, fistulas, strictures, or cardiac pacemakers, as well as pregnant women, and individuals who could not accept the capsule-retention or capsule-removal surgery were excluded. Patients with heart, lung and other vital organ failure diseases were also excluded. Everyone involved in this study had undergone CE and DBE. The results were divided into: (1) the definite diagnosis (the diagnosis was confirmed at least by one of the biopsy, surgery, pathology or the drug treatment effects with follow-up for at least 3 mo); (2) the possible diagnosis (a possible diagnosis was suggested by CE or DBE, but not confirmed by the biopsy, surgery or follow-up drug treatment effects); and (3) the unclear diagnosis (no exact causes were provided by CE and DBE for the disease). The detection rate and the diagnostic yield of the two methods were compared. in the etiologies between CE and DBE was estimated, and the different possible etiologies caused by the age groups were also investigated. METHODS: From June 2009 toRESULTS: CE exhibited a better trend than DBE for diagnosing scattered small ulcers (P = 0.242, Fisher' s test), and small vascular malformations (χ 2 = 1.810, P = 0.179, Pearson χ 2 test), but with no significant differences, possible due to few cases. However, DBE was better than CE for larger tumors (P = 0.018, Fisher's test) and for diverticular lesions with bleeding ulcers (P = 0.005, Fisher's test). All three hemangioma cases diagnosed by DBE in this study (including sponge hemangioma, venous hemangioma, and hemangioma with hamartoma lesions) were all confirmed by biopsy. Two parasite cases were found by CE, but were negative by DBE. This study revealed no obvious differences in the detection rates (DR) of CE (60.0%, 53/88) and DBE (59.1%, 52/88). However, the etiological diagnostic yield (DY) difference was apparent. The CE diagnostic yield was 42.0% (37/88), and the DBE diagnostic yield was 51.1% (45/88). Furthermore, there were differences among the age groups (χ 2 = 22.146, P = 0.008, Kruskal Wallis Test). Small intestinal cancer (5/6 cases), vascular malformations (22/29 cases), and active bleeding (3/4 cases) appeared more commonly in the patients over 50 years old, but diverticula with bleeding ulcers were usually found in the 15-25-year group (4/7cases). The over-25-year group accounted for the stromal tumors (10/12 cases).CONCLUSION: CE and DBE each have their own advantages and disadvantages. The appropriate choice depends on the patient's age, tolerance, and clinical manifestations. Sometimes CE followed by DBE is necessary. Core t...

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Single- vs. double-balloon enteroscopy in small-bowel diagnostics: a randomized multicenter trial

Abstract: This head-to-head comparison study shows that DBE and SBE have a comparable performance and diagnostic yield for evaluation of the small bowel.

Cited by 167 publications

References 14 publications

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

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

Modern Imaging Techniques: Which - When - Why?

Different roles of capsule endoscopy and double-balloon enteroscopy in obscure small intestinal diseases

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