Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 28, 2016; 22(48): 10625-10630
Published online Dec 28, 2016. doi: 10.3748/wjg.v22.i48.10625
Capsule endoscopy and single-balloon enteroscopy in small bowel diseases: Competing or complementary?
Jing-Jing Ma, Ying Wang, Xiao-Min Xu, Jie-Wen Su, Wen-Yu Jiang, Jian-Xia Jiang, Lin Lin, Dao-Quan Zhang, Jing Ding, Li Chen, Ting Jiang, Ying-Hong Xu, Gui Tao, Hong-Jie Zhang
Jing-Jing Ma, Xiao-Min Xu, Jie-Wen Su, Wen-Yu Jiang, Jian-Xia Jiang, Lin Lin, Dao-Quan Zhang, Jing Ding, Li Chen, Ting Jiang, Ying-Hong Xu, Gui Tao, Hong-Jie Zhang, Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
Ying Wang, Department of Gastroenterology, Jiangsu Provincial Hospital, Nanjing 210024, Jiangsu Province, China
Author contributions: Ma JJ, Wang Y and Xu XM contributed equally to this study; Ma JJ and Wang Y performed the study; Ma JJ, Xu XM, Su JW and Jiang WY carried out data analysis and wrote the paper; Ma JJ, Wang Y, Jiang JX, Lin L, Zhang DQ, Ding J, Chen L, Jiang T, Xu YH, Tao G and Zhang HJ performed capsule endoscopy and single balloon enteroscopy; Ma JJ and Zhang HJ designed the study; Zhang HJ supervised the report; all authors read and approved the final version to be published.
Supported by the Key Medical Personnel of Jiangsu Province, No. RC2011063.
Institutional review board statement: This study was reviewed and approved by the institutional review board of the First Affiliated Hospital of Nanjing Medical University.
Informed consent statement: All patients, or their legal guardians, provided informed written consent prior to capsule endoscopy or single-balloon enteroscopy. Patients were not required to give informed consent for inclusion in the study, as the analysis used anonymous clinical data. Individuals cannot be identified according to the data presented.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: 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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hong-Jie Zhang, PhD, Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, Jiangsu Province, China. hjzhang06@163.com
Telephone: +86-25-83718836-6920 Fax: +86-25-83674636
Received: August 21, 2016
Peer-review started: August 22, 2016
First decision: October 11, 2016
Revised: October 25, 2016
Accepted: November 14, 2016
Article in press: November 16, 2016
Published online: December 28, 2016
Abstract
AIM

To evaluate diagnostic yields of capsule endoscopy (CE) and/or single-balloon enteroscopy (SBE) in patients with suspected small bowel diseases.

METHODS

We retrospectively analyzed 700 patients with suspected small bowel diseases from September 2010 to March 2016. CE, SBE, or SBE with prior CE was performed in 401, 353, and 47 patients, respectively. Data from clinical and endoscopy records were collected for analysis. Indications, procedure times, diagnostic yields, and complications were summarized and evaluated.

RESULTS

The overall diagnostic yield for the CE group was 57.6%. The diagnostic yield of CE in patients with obscure gastrointestinal bleeding (OGIB) was significantly greater than that in patients with no bleeding (70.5% vs 43.8%, P < 0.01). The overall diagnostic yield of SBE was 69.7%. There was no difference in the diagnostic yield of SBE between patients with OGIB and those with no bleeding (72.5% vs 68.9%, P = 0.534). Forty-seven patients underwent CE prior to SBE. Among them, the diagnostic yield of SBE with positive findings on prior CE was 93.3%. In addition, SBE detected two cases with superficial ulcer and erosive lesions in the small bowel, which were missed by CE. However, one case with lymphoma and two with Crohn’s disease were not confirmed by SBE. The rate of capsule retention was 2.0%. There were no significant complications during or after SBE examinations.

CONCLUSION

SBE is a safe and effective technique for diagnosing small bowel diseases. SBE with prior CE seemed to improve the diagnostic yield of small bowel diseases.

Keywords: Capsule endoscopy, Small bowel diseases, Single-balloon enteroscopy, Diagnosis, Balloon-assisted enteroscopy

Core tip: The aims of this study were to evaluate diagnostic yields associated with capsule endoscopy (CE), single-balloon enteroscopy (SBE), or their combined use in patients with suspected small bowel diseases, as well as to demonstrate the appropriate diagnostic algorithms for diagnosing different small bowel diseases. This study revealed the diagnostic yield of SBE with positive findings on prior CE was high (93.3%). CE followed by SBE represents an especially effective strategy for determining the cause of small bowel disease when findings from an initial CE examination are indeterminate.