Diagnostic yield of capsule endoscopy vs. double-balloon endoscopy for patients who have undergone total enteroscopy with obscure gastrointestinal bleeding.

Background/aims: The usefulness of capsule endoscopy (CE) and of double-balloon endoscopy (DBE) for detection of small-bowel lesions is widely accepted. We compared CE- and DBE-based detection of small-bowel lesions in patients with obscure gastrointestinal bleeding (OGIB) who underwent total enteroscopy by both CE and DBE.

Methodology: One hundred eighteen consecutive patients (70 men, 48 women; mean age 62.9±18.4 years) with OGIB underwent both CE and DBE. CE was performed and DBE was then performed within 1 week by both retrograde and antegrade approaches. Differences in detection rates were analyzed.

Results: Overall, small-bowel lesions were detected by CE in 53 patients (44.9%) and by DBE in 63 patients (53.4%) (p=0.01); agreement between CE and DBE findings was good (kappa statistic=0.76). Total enteroscopy was achieved by both modalities in 54 patients; CE detected small-bowel lesions in 25 of these patients (46.3%), and DBE detected lesions in 28 of these patients (51.9%) (p=0.25); agreement between CE and DBE findings was very good (kappa statistic=0.88).

Conclusions: Our data support preferential use of noninvasive CE for patients with OGIB and subsequent DBE examination in most cases.