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Preliminary Comparison of Capsule Endoscopy and Double-Balloon Enteroscopy in Patients with Suspected Small-Bowel Bleeding
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2006
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Capsule endoscopy and double‑balloon enteroscopy are emerging techniques that allow complete examination of the small bowel. This study aimed to evaluate the clinical utility of CE and DBE in patients with suspected small‑bowel bleeding to clarify their respective roles and indications. In a prospective cohort of 32 patients with obscure gastrointestinal bleeding, 28 underwent both CE and DBE, with lesions classified as A1 (requiring immediate hemostasis) or A2 (requiring observation), and the procedures’ ability to traverse the entire small bowel and yield diagnoses was compared. CE achieved a significantly higher complete‑bowel access rate (90.6 % vs 62.5 %) and a higher, though not statistically significant, diagnostic rate (59.4 % vs 42.9 %), leading the authors to recommend CE for initial diagnosis and DBE for subsequent treatment or histopathology.
Capsule endoscopy (CE) and double-balloon enteroscopy (DBE) have been introduced as modalities for examining the entire small bowel. The aim of the present study was to assess the clinical effects of CE and DBE to consider the roles of CE and DBE and the indications for the procedures in patients with suspected small-bowel bleeding.Between June 2004 and January 2005, 32 patients in whom a site of bleeding in the gastrointestinal tract had not been identified were enrolled in the study. Twenty-eight patients were examined with both methods. Bleeding sources were categorized as either A1 lesions (immediate hemostatic procedures required) or A2 lesions (close observation required). CE and DBE were evaluated with regard to whether or not they were capable of accessing the entire small bowel and provided a diagnosis, and the access and diagnostic rates were calculated.On CE, 13 patients were diagnosed with A1 lesions and six with A2 lesions; on DBE, 11 had A1 lesions and one had an A2 lesion. The access rate for the entire small intestine on CE was 90.6 % (29 of 32), significantly higher than with DBE at 62.5 % (10 of 16; P < 0.05). The diagnostic rate on CE was 59.4 % (19 of 32), higher than with DBE at 42.9 % (12 of 28; P = 0.30), but not significantly different. Among patients with A1 lesions who were diagnosed with DBE, histological diagnoses were obtained in six of the 11, and three patients were treated.In many suspected small-bowel bleeding cases, CE should be selected for the initial diagnosis and DBE for treatment or histopathological diagnosis after detection of the bleeding site on CE.