title: Clinically significant small-bowel pathology identified by double-balloon enteroscopy but missed by capsule endoscopy.
abstract: BACKGROUND
  Capsule endoscopy (CE) is increasingly being used to investigate the small bowel for various indications, including obscure GI bleeding (OGB). However, false negatives have been described. Double-balloon enteroscopy (DBE) is a new endoscopic technique developed to potentially view the entire small intestine while allowing therapeutic options to be carried out when appropriate.
  
  
  OBJECTIVE
  We described 4 patients with small-bowel pathology missed on CE but detected by DBE.
  
  
  METHODS
  Descriptive retrospective study. All patients underwent CE followed by DBE.
  
  
  METHODS
  Single-center tertiary referral hospital.
  
  
  METHODS
  Four patients were included. Three patients had OGB that required blood transfusions. One patient with celiac disease, compliant on a strict gluten-free diet for 5 months, presented with persistent weight loss and abdominal pain.
  
  
  METHODS
  DBE followed by surgical exploration and resection of small-bowel pathology.
  
  
  METHODS
  Successful identification of pathology missed by CE. Definitive treatment of small-bowel pathology by surgical resection.
  
  
  RESULTS
  CE did not identify the small-bowel pathology in all 4 patients. The 3 patients with OGB had small-bowel masses found by DBE. Two of these were GI stromal tumors and one was an adenocarcinoma. The patient with celiac disease had a malignant ulcer, confirmed to be a lymphoma after surgical resection.
  
  
  CONCLUSIONS
  Retrospective study and small sample size.
  
  
  CONCLUSIONS
  CE and DBE are complementary investigations. If there is a high index of suspicion of small-bowel pathology despite a negative CE, DBE should be performed.
authors.affiliation: Department of Gastroenterology, Bankstown Hospital, Bankstown, New South Wales, Australia.
authors.forename: André K H
authors.initials: AK
authors.lastname: Chong
authors.forename: Bernard W K
authors.initials: BW
authors.lastname: Chin
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Meredith
mesh_terms: D003951:Diagnostic Errors; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006801:Humans; D007414:Intestinal Neoplasms / Q000473:pathology*; D007421:Intestine, Small / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies