Meta-Analysis
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Dec 16, 2018; 10(12): 400-421
Published online Dec 16, 2018. doi: 10.4253/wjge.v10.i12.400
Video capsule endoscopy vs double-balloon enteroscopy in the diagnosis of small bowel bleeding: A systematic review and meta-analysis
Hélcio Pedrosa Brito, Igor Braga Ribeiro, Diogo Turiani Hourneaux de Moura, Wanderley Marques Bernardo, Dalton Marques Chaves, Rogério Kuga, Ethan Dwane Maahs, Robson Kiyoshi Ishida, Eduardo Turiani Hourneaux de Moura, Eduardo Guimarães Hourneaux de Moura
Hélcio Pedrosa Brito, Igor Braga Ribeiro, Diogo Turiani Hourneaux de Moura, Wanderley Marques Bernardo, Dalton Marques Chaves, Rogério Kuga, Robson Kiyoshi Ishida, Eduardo Turiani Hourneaux de Moura, Eduardo Guimarães Hourneaux de Moura, Department of Endoscopy of Clinics Hospital of São Paulo University, São Paulo 05403-00, Brazil
Ethan Dwane Maahs, Molecular and Cell Biology, University of California, California, Berkeley, CA 94720, United States
Author contributions: Brito HP acquisition of data, analysis, interpretation of data, drafting of the article, revision of the article, final approval; Bernardo WM analysis and interpretation of data, drafting of the article, final approval; Chaves DM acquisition of data, drafting of the article, revision of the article, final approval; de Moura DTH and Ribeiro IB: analysis and interpretation of data, revision of the article; Kuga R acquisition of data, drafting of the article, revision of the article, Maahs ED revision of the article; de Moura ETH drafting of the article, revision of the article; de Moura EGH analysis and interpretation of data, drafting of the article, revision of the article, final approval; de Moura EGH: conception and design of the study, critical revision, final approval.
Conflict-of-interest statement: The authors deny any conflict of interest.
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/
Corresponding author to: Igor Braga Ribeiro, MD, Academic Fellow, Surgeon, Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar 255, Instituto Central, Prédio dos Ambulatórios, Pinheiros, São Paulo 05403-000, Brazil. igorbraga1@gmail.com
Telephone: +55-92-981377788
Received: July 25, 2018
Peer-review started: July 27, 2018
First decision: August 20, 2018
Revised: August 31, 2018
Accepted: November 15, 2018
Article in press: November 15, 2018
Published online: December 16, 2018
Abstract
AIM

To compare the diagnostic accuracy of video capsule endoscopy (VCE) and double-balloon enteroscopy (DBE) in cases of obscure gastrointestinal bleeding (OGIB) of vascular origin.

METHODS

MEDLINE (via PubMed), LILACS (via BVS) and Cochrane/CENTRAL virtual databases were searched for studies dated before 2017. We identified prospective and retrospective studies, including observational, cohort, single-blinded and multicenter studies, comparing VCE and DBE for the diagnosis of OGIB, and data of all the vascular sources of bleeding were collected. All patients were subjected to the same gold standard method. Relevant data were then extracted from each included study using a standardized extraction form. We calculated study variables (sensitivity, specificity, prevalence, positive and negative predictive values and accuracy) and performed a meta-analysis using Meta-Disc software.

RESULTS

In the per-patient analysis, 17 studies (1477 lesions) were included. We identified 3150 exams (1722 VCE and 1428 DBE) in 2043 patients and identified 2248 sources of bleeding, 1467 of which were from vascular lesions. Of these lesions, 864 (58.5%) were diagnosed by VCE, and 613 (41.5%) were diagnosed by DBE. The pretest probability for bleeding of vascular origin was 54.34%. The sensitivity of DBE was 84% (95%CI: 0.82-0.86; heterogeneity: 78.00%), and the specificity was 92% (95%CI: 0.89-0.94; heterogeneity: 92.0%). For DBE, the positive likelihood ratio was 11.29 (95%CI: 4.83-26.40; heterogeneity: 91.6%), and the negative likelihood ratio was 0.20 (95%CI: 0.15-0.27; heterogeneity: 67.3%). Performing DBE after CE increased the diagnostic yield of vascular lesion by 7%, from 83% to 90%.

CONCLUSION

The diagnostic accuracy of detecting small bowel bleeding from a vascular source is increased with the use of an isolated video capsule endoscope compared with isolated DBE. However, concomitant use increases the detection rate of the bleeding source.

Keywords: Small bowel bleeding, Hemorrhage, Upper gastrointestinal bleeding, Obscure hemorrhage, Enteroscopy

Core tip: We performed a systematic review and meta-analysis comparing the diagnostic accuracy of video capsule endoscopy and double-balloon enteroscopy (DBE) in cases of obscure gastrointestinal bleeding of vascular origin. This is the first systematic review in this setting. We observed that the diagnostic accuracy of detecting small bowel bleeding from a vascular source is increased with the use of an isolated video capsule endoscope compared with isolated DBE. However, concomitant use increases the detection rate of the bleeding source.