Investigating obscure gastrointestinal bleeding: capsule endoscopy or double balloon enteroscopy?

Area of Science:

• Gastroenterology
• Endoscopy
• Diagnostic Imaging

Background:

• Small bowel visualization has advanced with capsule endoscopy (CE) and double balloon enteroscopy (DBE).
• These techniques are standard for investigating small bowel diseases, particularly obscure gastrointestinal bleeding (OGIB).
• Current practice varies, with some advocating CE and others DBE for OGIB evaluation.

Purpose of the Study:

• To systematically review studies comparing CE and DBE in patients with OGIB.
• To assess the diagnostic yields and therapeutic capabilities of both CE and DBE for OGIB.
• To provide practical guidelines for OGIB evaluation.

Main Methods:

• Systematic review of studies involving patients with OGIB who underwent both CE and DBE.
• Comparative analysis of diagnostic yields and therapeutic intervention rates.
• Evaluation of procedural concordance and potential for false negatives.

Main Results:

• CE and DBE demonstrate comparable diagnostic yields for OGIB, ranging from 50% to 60%.
• Therapeutic interventions were feasible with DBE in 11% to 57% of cases.
• While concordance between CE and DBE is generally good, both methods can yield false-negative results.

Conclusions:

• CE and DBE are valuable tools for investigating OGIB with similar diagnostic accuracy.
• Capsule endoscopy is recommended as the first-line investigation for OGIB due to its safety profile and comprehensive visualization.
• Double balloon enteroscopy serves as a subsequent option, particularly for therapeutic interventions.