title: Predictability of capsule endoscopy referred to a tertiary care center for double-balloon enteroscopy.
abstract: OBJECTIVE
  Patients with obscure gastrointestinal bleeding with 'positive' findings on video capsule endoscopy (VCE) by gastroenterologists practicing in the community are often referred to tertiary care centers for double-balloon enteroscopy (DBE). Our study explores the degree of concordance between these two procedures performed in two different clinical settings.
  
  
  METHODS
  Concordance between the procedures was estimated using a κ-coefficient.
  
  
  RESULTS
  A total of 73 patients with obscure gastrointestinal bleeding were referred to our center for DBE after undergoing VCE elsewhere. Ten of these patients (10/73 or 13.7%) had been found to have bleeding in the small bowel on VCE without any concrete diagnosis. DBE revealed the source of bleeding in 17 of the 22 patients (77.3%) with normal VCE. The referral diagnosis was correct in 31 cases (31/73 or 42.5%). The κ-coefficient for VCE and DBE for the 63 patients was 0.28, suggesting poor agreement between the two procedures. However, most patients with a referral diagnosis of vascular pathology were confirmed to have vascular disease on DBE (19/23 or 82.6%).
  
  
  CONCLUSIONS
  Our study shows that there is a poor concordance between capsule endoscopy performed in the community and confirmatory DBE performed at our tertiary care center.
authors.affiliation: Departments of aMedicine bGastroenterology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Jatinder
authors.initials: J
authors.lastname: Goyal
authors.forename: Hwasoon
authors.initials: H
authors.lastname: Kim
authors.forename: Ali S
authors.initials: AS
authors.lastname: Khan
authors.forename: Klaus
authors.initials: K
authors.lastname: Monkemuller
authors.forename: Shajan
authors.initials: S
authors.lastname: Peter
mesh_terms: D053704:Capsule Endoscopy; D003153:Community Health Services; D058582:Double-Balloon Enteroscopy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D041981:Gastrointestinal Tract / Q000473:pathology*; D006801:Humans; D008297:Male; D015588:Observer Variation; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012017:Referral and Consultation; D015203:Reproducibility of Results; D062606:Tertiary Care Centers