Prospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 21, 2015; 21(23): 7297-7304
Published online Jun 21, 2015. doi: 10.3748/wjg.v21.i23.7297
Different roles of capsule endoscopy and double-balloon enteroscopy in obscure small intestinal diseases
Zhi-Hong Zhang, Chun-Hua Qiu, Yi Li
Zhi-Hong Zhang, Chun-Hua Qiu, Yi Li, Department of Gastroenterology, Sichuan Provincial People’s Hospital, Sichuan Provincial Academy of Medical Sciences, Chengdu 610072, Sichuan Province, China
Author contributions: Zhang ZH was involved in designing the study, collecting the data, drafting the article, and making the critical revisions; Qiu CH supplied partial economic support, and took part in designing the study and revising the manuscript; Li Y provided technical support and gave some critical suggestions for revising the article; all members participated in the procedure.
Ethics approval: This study was reviewed and approved by the Ethics Committee of Sichuan Province Institution, Sichuan Provincial People’s Hospital Institutional Review Board.
Clinical trial registration: This study is registered at the Chinese Clinical Trail Registry. The registration identification number is ChiCTR-DCD-15005999.
Informed consent: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest: No potential conflicts of interest relevant to this article were reported.
Data sharing: The technical support and dataset available at, and The participants’ consent was not obtained; The presented data are anonymized and the risk of identification is low. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Chun-Hua Qiu, MD, Department of Gastroenterology, Sichuan Provincial People’s Hospital, Sichuan Provincial Academy of Medical Sciences, No. 32 Yihuan Road, Chengdu 610072, Sichuan Province, China.
Telephone: +86-28-87394207
Received: January 28, 2015
Peer-review started: January 29, 2015
First decision: February 10, 2015
Revised: February 27, 2015
Accepted: April 28, 2015
Article in press: April 28, 2015
Published online: June 21, 2015

AIM: To compare the roles of capsule endoscopy (CE) and double-balloon enteroscopy (DBE) in the diagnosis of obscure small bowel diseases.

METHODS: From June 2009 to December 2014, 88 patients were included in this study; the patients had undergone gastroscopy, colonoscopy, radiological small intestinal barium meal, abdominal computed tomography or magnetic resonance imaging scan and mesenteric angiography, but their diagnoses were still unclear. The patients with gastrointestinal obstructions, fistulas, strictures, or cardiac pacemakers, as well as pregnant women, and individuals who could not accept the capsule-retention or capsule-removal surgery were excluded. Patients with heart, lung and other vital organ failure diseases were also excluded. Everyone involved in this study had undergone CE and DBE. The results were divided into: (1) the definite diagnosis (the diagnosis was confirmed at least by one of the biopsy, surgery, pathology or the drug treatment effects with follow-up for at least 3 mo); (2) the possible diagnosis (a possible diagnosis was suggested by CE or DBE, but not confirmed by the biopsy, surgery or follow-up drug treatment effects); and (3) the unclear diagnosis (no exact causes were provided by CE and DBE for the disease). The detection rate and the diagnostic yield of the two methods were compared. The difference in the etiologies between CE and DBE was estimated, and the different possible etiologies caused by the age groups were also investigated.

RESULTS: CE exhibited a better trend than DBE for diagnosing scattered small ulcers (P = 0.242, Fisher’s test), and small vascular malformations (χ2 = 1.810, P = 0.179, Pearson χ2 test), but with no significant differences, possible due to few cases. However, DBE was better than CE for larger tumors (P = 0.018, Fisher’s test) and for diverticular lesions with bleeding ulcers (P = 0.005, Fisher’s test). All three hemangioma cases diagnosed by DBE in this study (including sponge hemangioma, venous hemangioma, and hemangioma with hamartoma lesions) were all confirmed by biopsy. Two parasite cases were found by CE, but were negative by DBE. This study revealed no obvious differences in the detection rates (DR) of CE (60.0%, 53/88) and DBE (59.1%, 52/88). However, the etiological diagnostic yield (DY) difference was apparent. The CE diagnostic yield was 42.0% (37/88), and the DBE diagnostic yield was 51.1% (45/88). Furthermore, there were differences among the age groups (χ2 = 22.146, P = 0.008, Kruskal Wallis Test). Small intestinal cancer (5/6 cases), vascular malformations (22/29 cases), and active bleeding (3/4 cases) appeared more commonly in the patients over 50 years old, but diverticula with bleeding ulcers were usually found in the 15-25-year group (4/7cases). The over-25-year group accounted for the stromal tumors (10/12 cases).

CONCLUSION: CE and DBE each have their own advantages and disadvantages. The appropriate choice depends on the patient’s age, tolerance, and clinical manifestations. Sometimes CE followed by DBE is necessary.

Keywords: Capsule endoscopy, Double-balloon enteroscopy, Obscure small intestinal diseases

Core tip: Until now, because of the expensive cost and difficult technology, a study of capsule endoscopy (CE) followed by double-balloon enteroscopy (DBE) simultaneously in one case has been rarely reported. To assess the role of CE and DBE in the diagnosis of small bowel diseases, this study was designed to choose the more appropriate examination (between CE and DBE) for obscure small bowel diseases.