A prospective, single-blind trial comparing wireless capsule endoscopy and double-balloon enteroscopy in patients with obscure gastrointestinal bleeding.
BACKGROUND
Wireless capsule endoscopy (CE) and double-balloon enteroscopy (DBE) are new methods enabling diagnostic endoscopy of the entire small intestine. However, which of the two is superior is unclear. We therefore prospectively compared the clinical efficacy of CE and DBE.


METHODS
We prospectively examined 32 patients with obscure gastrointestinal bleeding. CE preceded DBE by 1-7 days, and all patients underwent DBE twice, by antegrade and retrograde approaches, to evaluate the entire small intestine. Physicians evaluating the results of CE and DBE were blind to the results of the other method. We evaluated diagnosis, diagnostic yield of the two methods, and clinical outcomes.


RESULTS
CE revealed abnormal findings in 29 (90.6%) of 32 patients. CE definitively or probably detected the sources of bleeding in 23 (71.9%) of the 32 patients, including angioectasias (eight), erosions (seven), ulcers (five), tumor (one), and hemorrhagic polyps (two). DBE definitely or probably detected the sources of bleeding in 21 (65.6%) of the 32 patients, including angioectasias (seven), erosions (four), ulcers (five), tumor (one), hemorrhagic polyps (two) and diverticula (two). CE yielded more abnormal findings than DBE (CE 90.6%, DBE 65.6%) (P = 0.032), although there were no significant differences in diagnostic yield between the methods. We were able to perform additional treatment or biopsy with DBE in 13 patients, including coagulation therapy (ten), endoscopic mucosal resection (one), biopsy (seven), and extraction of retained CE (two).


CONCLUSIONS
Our results demonstrate the superiority of CE in detecting abnormal lesions, and the superiority of DBE in endoscopic management.
Kameda
Natsuhiko
N
Department of Gastroenterology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
Higuchi
Kazuhide
K
Shiba
Masatsugu
M
Machida
Hirohisa
H
Okazaki
Hirotoshi
H
Yamagami
Hirokazu
H
Tanigawa
Tetsuya
T
Watanabe
Kenji
K
Watanabe
Toshio
T
Tominaga
Kazunari
K
Fujiwara
Yasuhiro
Y
Oshitani
Nobuhide
N
Arakawa
Tetsuo
T
D000368:Aged; D053704:Capsule Endoscopy; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D007421:Intestine, Small; D008297:Male; D008875:Middle Aged; D016037:Single-Blind Method