A meta-analysis of the yield of capsule endoscopy compared to double-balloon enteroscopy in patients with small bowel diseases.
OBJECTIVE
To compare the diagnostic yield of capsule endoscopy (CE) with that of double-balloon enteroscopy (DBE).


METHODS
Pubmed, Embase, Elsevier ScienceDirect, the China Academic Journals Full-text Database, and Cochrane Controlled Trials Register were searched for the trials comparing the yield of CE with that of DBE. Outcome measure was odds ratio (OR) of the yield. Fixed or random model method was used for data analysis.


RESULTS
Eight studies (n = 277) which prospectively compared the yield of CE and DBE were collected. The results of meta-analysis indicated that there was no difference between the yield of CE and DBE [170/277 vs 156/277, OR 1.21 (95% CI: 0.64-2.29)]. Based on sub analysis, the yield of CE was significantly higher than that of double-balloon enteroscopy without combination of oral and anal insertion approaches [137/219 vs 110/219, OR 1.67 (95% CI: 1.14-2.44), P < 0.01), but not superior to the yield of DBE with combination of the two insertion approaches [26/48 vs 37/48, OR 0.33 (95% CI: 0.05-2.21), P > 0.05)]. A focused meta-analysis of the fully published articles concerning obscure GI bleeding was also performed and showed similar results wherein the yield of CE was significantly higher than that of DBE without combination of oral and anal insertion approaches [118/191 vs 96/191, fixed model: OR 1.61 (95% CI: 1.07-2.43), P < 0.05)] and the yield of CE was significantly lower than that of DBE by oral and anal combinatory approaches [11/24 vs 21/24, fixed model: OR 0.12 (95% CI: 0.03-0.52), P < 0.01)].


CONCLUSIONS
With combination of oral and anal approaches, the yield of DBE might be at least as high as that of CE. Decisions made regarding the initial approach should depend on patient's physical status, technology availability, patient's preferences, and potential for therapeutic endoscopy.
Chen
Xiang
X
Department of gastroenterology, Renji Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai Institute of Digestive Disease, Shanghai 200001, China.
Ran
Zhi-Hua
ZH
Tong
Jin-Lu
JL
D053704:Capsule Endoscopy / Q000379:methods*; D002404:Catheterization; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D007410:Intestinal Diseases / Q000175:diagnosis* / Q000473:pathology; D007421:Intestine, Small / Q000473:pathology
Am J Gastroenterol. 2006 Sep;101(9):2016-24
16968508
Endoscopy. 2005 Sep;37(9):827-32
16116533
Gastrointest Endosc. 2005 Jul;62(1):62-70
15990821
Endoscopy. 2006 Jan;38(1):49-58
16429355
Tech Vasc Interv Radiol. 2004 Sep;7(3):130-5
16015557
Gastrointest Endosc. 2006 Nov;64(5):740-50
17055868
Gastrointest Endosc. 2005 Jul;62(1):71-5
15990822
Best Pract Res Clin Gastroenterol. 2006 Feb;20(1):179-94
16473807
Gastrointest Endosc Clin N Am. 1999 Jan;9(1):61-9
9834317
Curr Opin Gastroenterol. 2005 Sep;21(5):573-7
16093772
Am J Gastroenterol. 2005 Nov;100(11):2407-18
16279893
Endoscopy. 2003 Oct;35(10):861-4
14551867
Endoscopy. 2006 Jan;38(1):59-66
16429356
Am J Gastroenterol. 2006 Jan;101(1):52-7
16405533