title: Degree of concordance between single balloon enteroscopy and capsule endoscopy for obscure gastrointestinal bleeding after an initial positive capsule endoscopy finding.
abstract: BACKGROUND
  In patients with obscure gastrointestinal bleeding (OBGIB) capsule endoscopy (CE) is the initial diagnostic procedure of choice. Often patients undergo single balloon enteroscopy (SBE) with both diagnostic and therapeutic intention after CE. Although SBE offers a therapeutic benefit, long procedure times, complexity, and invasiveness are drawbacks. We aimed to evaluate the diagnostic correlation between these two modalities after an initial positive CE finding.
  
  
  METHODS
  We performed a retrospective review of 418 patients who underwent CE at our institution from January 2010 to May 2014. A total of 95 patients were analyzed after selecting patients that underwent SBE originally after a positive CE result for the evaluation for OGIB. Agreement beyond chance was evaluated using the κ coefficient. A p value less than 5% was considered statistically significant.
  
  
  RESULTS
  The mean age of our population was 65.8 ± 12.2 and it was female predominant: 57/95 (60%). The most frequent positive findings were vascular lesions found on SBE in 31.6% and on CE in 41.1%. There was a strong agreement when identifying active bleeding and clots [κ=0.97; 95% confidence interval (CI) 0.92-1.03; p ⩽ 0.0001], and a moderate agreement when diagnosing vascular lesions (0.41; 95% CI 0.21-0.61; p ⩽ 0.0001). There was fair agreement for ulcers (0.26; 95% CI 0.07-0.59; p = 0.005). There was a low correlation between masses, polyps, and others.
  
  
  CONCLUSIONS
  CE still remains the initial test of choice in evaluating stable patients with OBGIB since it has strong-to-fair concordance for the major small bowel findings. However, in cases of severe overt small bowel bleeding, balloon-assisted enteroscopy can be considered the initial procedure of choice since it is therapeutic as well as diagnostic and this approach avoids delays in treatment. Further research should focus on methods to improve interpretation of CE and enhance the ability to evaluate the entire small bowel with SBE.
authors.affiliation: Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
authors.forename: Ashok
authors.initials: A
authors.lastname: Shiani
authors.affiliation: Department of Internal Medicine, Division of Digestive Diseases and Nutrition, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
authors.forename: Javier
authors.initials: J
authors.lastname: Nieves
authors.affiliation: Department of Internal Medicine, Division of Digestive Diseases and Nutrition, University of South Florida Morsani College of Medicine, 12901 Bruce B. Downs Blvd, MDC 72, Tampa, FL 33612, USA.
authors.forename: Seth
authors.initials: S
authors.lastname: Lipka
authors.affiliation: Department of Internal Medicine, Division of Digestive Diseases and Nutrition, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
authors.forename: Brijesh
authors.initials: B
authors.lastname: Patel
authors.affiliation: Department of Evidence Based Medicine and Outcomes Research, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
authors.forename: Ambuj
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Department of Internal Medicine, Division of Digestive Diseases and Nutrition, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Brady
keywords: capsule endoscopy; concordance; obscure gastrointestinal bleed; small bowel enteroscopy