title: Evaluating the role of small-bowel endoscopy in clinical practice:  the largest single-centre experience.
abstract: OBJECTIVE
  There are few centres that offer all forms of small-bowel endoscopic modalities [capsule endoscopy (CE), push enteroscopy (PE), double-balloon enteroscopy (DBE) or single-balloon enteroscopy and intraoperative enteroscopy (IOE)]. Previous investigators have suggested that DBE may be more cost-effective as the first-line investigation. We evaluated the relationship among four modalities of small-bowel endoscopy in terms of demand, diagnostic yield, patient management and tolerability.
  
  
  METHODS
  Data were collected on patients who underwent PE and IOE since January 2002, CE since June 2002 and DBE since July 2006. These included age, sex, indication of referral, comorbidity, previous investigations and diagnosis obtained, including subsequent management change.
  
  
  RESULTS
  Demand for CE and DBE increased every year. A total of 1431 CEs, 247 PEs, 102 DBEs and 17 IOEs were performed over 93 months. The diagnostic yield was 88% for IOE compared with 34.6% for CE, 34.5% for PE and 43% for DBE (P<0.001). Management was altered by CE in 25%, by PE in 19% and by DBE in 33% of patients. However, 44% of patients who underwent DBE found the procedure difficult to tolerate. In 2009, for every 17 CEs performed, one patient underwent DBE locally.
  
  
  CONCLUSIONS
  This is the first series to report the clinical experience of four modalities of small-bowel endoscopy from a single centre. The use of CE as first-line investigation, followed by PE/DBE or IOE, is potentially both less invasive and tolerable.
authors.affiliation: Department of Gastroenterology, Gastroenterology and Liver Unit, Royal Hallamshire Hospital, Glossop Road, Sheffield, UK. reena_sidhu@yahoo.com
authors.forename: Reena
authors.initials: R
authors.lastname: Sidhu
authors.forename: Mark E
authors.initials: ME
authors.lastname: McAlindon
authors.forename: Kaye
authors.initials: K
authors.lastname: Drew
authors.forename: Suzanne
authors.initials: S
authors.lastname: Hardcastle
authors.forename: Iain C
authors.initials: IC
authors.lastname: Cameron
authors.forename: David S
authors.initials: DS
authors.lastname: Sanders
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018798:Anemia, Iron-Deficiency / Q000209:etiology; D053704:Capsule Endoscopy / Q000379:methods / Q000706:statistics & numerical data; D002446:Celiac Disease / Q000175:diagnosis; D002648:Child; D003424:Crohn Disease / Q000175:diagnosis; D058582:Double-Balloon Enteroscopy / Q000379:methods / Q000706:statistics & numerical data; D016099:Endoscopy, Gastrointestinal / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D007410:Intestinal Diseases / Q000175:diagnosis*; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D055815:Young Adult