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. 2018 Dec 16;10(12):400-421.
doi: 10.4253/wjge.v10.i12.400.

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

Hélcio Pedrosa Brito  1 , Igor Braga Ribeiro  2 , Diogo Turiani Hourneaux de Moura  1 , Wanderley Marques Bernardo  1 , Dalton Marques Chaves  1 , Rogério Kuga  1 , Ethan Dwane Maahs  3 , Robson Kiyoshi Ishida  1 , Eduardo Turiani Hourneaux de Moura  1 , Eduardo Guimarães Hourneaux de Moura  1
Affiliations

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

Hélcio Pedrosa Brito et al. World J Gastrointest Endosc. .

Abstract

Aim: To compare the diagnostic accuracy of video capsule endoscopy (VCE) and double-balloon enteroscopy (DBE) in cases of obscure gastrointestinal bleeding (OGIB) of vascular origin.

Methods: MEDLINE (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.

Results: In 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%.

Conclusion: The 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.

Keywords: Enteroscopy; Hemorrhage; Obscure hemorrhage; Small bowel bleeding; Upper gastrointestinal bleeding.

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Conflict of interest statement

Conflict-of-interest statement: The authors deny any conflict of interest.

Figures

Figure 1
Figure 1
Flow diagrams - PRISMA[36].
Figure 2
Figure 2
Forrest plot: Double-balloon enteroscopy sensitivity per-lesion analysis.
Figure 3
Figure 3
Forrest plot: Double-balloon enteroscopy specificity per-patient analysis.
Figure 4
Figure 4
Forrest plot: Double-balloon enteroscopy positive likelihood ratio per-patient analysis.
Figure 5
Figure 5
Forrest plot: Double-balloon enteroscopy negative likelihood ratio per-patient analysis.
Figure 6
Figure 6
Summary receivers operating characteristic curve for double-balloon enteroscopy in per-patient analysis. sROC: Summary receiver operating characteristic.
Figure 7
Figure 7
Summary receiver operating characteristic curve for video capsule endoscopy in per-patient analysis. sROC: Summary receiver operating characteristic.
Figure 8
Figure 8
Suggested management approach to overt and occult small-bowel bleeding after upper endoscopy and colonoscopy did not identify vascular bleeding origin. Positive test results should direct specific therapy. When video capsule endoscopy is contraindicated or unavailable, device-assisted endoscopy may serve as the initial test for small-bowel evaluation. VCE: Video capsule endoscopy; DAE: Device-assisted endoscopy; DBE: Double-balloon enteroscopy.
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