Presentations in Endoscopy: Capsule Endoscopy

Capsule Endoscopy and Double-Balloon Enteroscopy Complementary for Detecting Small-Bowel Pathology

In a retrospective chart review of diagnostic procedures, researchers compared the diagnostic yield of capsule endoscopy versus double-balloon enteroscopy in the detection of small-bowel pathology. Outcomes were evaluated in consecutive patients who underwent both procedures, performed by the same endoscopist, between January 2005 and August 2006. The most common indication for double-balloon enteroscopy was obscure overt gastrointestinal bleeding (48%), followed by obscure occult gastrointestinal bleeding (32%), mucosal changes (10%), suspected mass (9%), and a retained capsule (1%). Of the 237 patients evaluated, 50.6% were male and the mean age was 65 years (range, 17—100 years). Abnormalities were detected in 72% of patients with double-balloon enteroscopy, compared to 68% with capsule endoscopy, yielding a nonsignificant trend toward agreement between the 2 tests (kappa value, 0.28; P=.06). Double-balloon enteroscopy revealed small-bowel pathology in 24 of 45 patients (53.3%) with negative results by capsule endos-copy. Seven of these cases involved small intestinal diver-ticula. Conversely, capsule endoscopy revealed suspected small-bowel pathology in 18 of 37 patients (48.6%) with negative results on double-balloon enteroscopy. The investigators concluded that the 2 techniques appear to be complementary. Whereas double-balloon enteroscopy appears to better detect small-bowel diverticula and normal variants, capsule endoscopy appears to better detect ulcers, masses, and active bleeding. The researchers noted that, although capsule endoscopy may result in some false-positives, double-balloon enteroscopy may identify normal variants in these cases.
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