Diagnostic value of capsule endoscopy and enteroscopy in small bowel diseases: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

YAN Tong , SHEN Qian , LI Minghui ,  ZHANG Jun

Department of Gastroenterology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210000, P.R.China;

Corresponding?author：

ZHANG Jun, Email: zhangjun711028@126.com

Keywords：

Capsule endoscopy; Enteroscopy; Small intestinal diseases; Diagnostic study; Meta-analysis

DOI：

10.7507/1672-2531.202011018

Video：

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Objective To systematically review the diagnostic value of capsule endoscopy and enteroscopy in small intestinal diseases.Methods PubMed, The Cochrane Library, Web of Science, CNKI, WanFang Data, and VIP databases were electronically searched to collect studies on the diagnosis of intestinal diseases by capsule endoscopy and enteroscopy from inception to August 31^st, 2020. Two reviewers independently screened literature, extracted data and assessed risk bias of included studies. Meta-analysis was then performed by using RevMan 5.3 and Meta-DiSc software.Results A total of 20 studies were included. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio for capsule endoscopy were 0.86 (95%CI 0.83 to 0.87), 0.81 (95%CI 0.78 to 0.84), 117.07 (95%CI 37.98 to 360.92), 7.20 (95%CI 2.81 to 18.45), 0.11 (95%CI 0.06 to 0.21), and those for enteroscopy were 0.89 (95%CI 0.87 to 0.90), 0.91 (95%CI 0.89 to 0.93), 196.99 (95%CI 72.63 to 534.26), 13.26 (95%CI 5.00 to 35.14), 0.12 (95%CI 0.07 to 0.21). The areas under the working characteristic curve (SROC) of capsule endoscopy and enteroscopy were 0.9692 and 0.9783, respectively.Conclusions Both capsule endoscopy and enteroscopy have high specificity and sensitivity in the diagnosis of small intestinal diseases, and enteroscopy has higher clinical value in the diagnosis of some small intestinal diseases than capsule endoscopy. Due to limited quantity and quality of the included studies, the above conclusions are required to be verified by more high-quality studies.

Citation： YAN Tong, SHEN Qian, LI Minghui, ZHANG Jun. Diagnostic value of capsule endoscopy and enteroscopy in small bowel diseases: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2021, 21(5): 566-572. doi: 10.7507/1672-2531.202011018 Copy

1.	Swain P, Adler D, Enns R. Capsule endoscopy in obscure intestinal bleeding. Endoscopy, 2005, 37(7): 655-659.
2.	Kahn E, Daum F. Anatomy, histology, embryology, and developmental anomalies of the small and large intestine. Available from: https://clinicalgate.com/anatomy-histology-embryology-and-developmental-anomalies-of-the-small-and-large-intestine/.
3.	Leighton JA, Wallace MB. Update on small bowel imaging. Gastroenterology, 2007, 132(5): 1651-1654.
4.	Gurudu SR, Vargas HE, Leighton JA. New frontiers in small-bowel imaging: the expanding technology of capsule endoscopy and its impact in clinical gastroenterology. Rev Gastroenterol Disord, 2008, 8(1): 1-14.
5.	鄔蘭, 張永, 曾憲濤. QUADAS-2 在診斷準確性研究的質量評價工具中的應用. 湖北醫藥學院學報, 2013, 32(3): 201-208.
6.	Shiani A, Nieves J, Lipka S, et al. Degree of concordance between single balloon enteroscopy and capsule endoscopy for obscure gastrointestinal bleeding after an initial positive capsule endoscopy finding. Therap Adv Gastroenterol, 2016, 9(1): 13-18.
7.	曹燕洪, 王學紅. 雙氣囊小腸鏡和膠囊內鏡對不明原因慢性腹痛診斷價值的比較. 中國醫藥導刊, 2019, 21(5): 278-281.
8.	Danialifar TF, Naon H, Liu QY. Comparison of diagnostic accuracy and concordance of video capsule endoscopy and double balloon enteroscopy in Children. J Pediatr Gastroenterol Nutr, 2016, 62(6): 824-827.
9.	Hermans C, Stronkhorst A, Tjhie-Wensing A, et al. Double-balloon endoscopy in overt and occult small bowel bleeding: results, complications, and correlation with prior video capsule endoscopy in a tertiary referral center. Clin Endosc, 2017, 50(1): 69-75.
10.	何瓊. 雙氣囊小腸鏡(DBE)和膠囊內鏡(CE)對可疑小腸疾病診斷價值研究. 南京: 南京醫科大學, 2013.
11.	Kalra AS, Walker AJ, Benson ME, et al. Comparison of capsule endoscopy findings to subsequent double balloon enteroscopy: a dual center experience. Diagn Ther Endosc, 2015, 2015: 438757.
12.	Otani K, Watanabe T, Shimada S, et al. Usefulness of small bowel reexamination in obscure gastrointestinal bleeding patients with negative capsule endoscopy findings: comparison of repeat capsule endoscopy and double-balloon enteroscopy. United European Gastroenterol J, 2018, 6(6): 879-887.
13.	李江波, 孫聰, 王玲玲, 等. 膠囊內鏡與雙氣囊小腸鏡在小腸疾病診斷中的價值初探. 中國藥物與臨床, 2020, 20(1): 61-63.
14.	Ma JJ, Wang Y, Xu XM, et al. Capsule endoscopy and single-balloon enteroscopy in small bowel diseases: competing or complementary? World J Gastroenterol, 2016, 22(48): 10625-10630.
15.	Marmo R, Rotondano G, Casetti T, et al. Degree of concordance between double-balloon enteroscopy and capsule endoscopy in obscure gastrointestinal bleeding: a multicenter study. Endoscopy, 2009, 41(7): 587-592.
16.	毛乙鴻, 張燕, 吳俊超. 膠囊內鏡和單氣囊小腸鏡診斷價值的對比. 醫藥前沿, 2017, 7(32): 32-34.
17.	Xu N, Yu Z, Cao X, et al. Characteristics of nonsteroidal anti-inflammatory drugs (NSAIDs)-induced small bowel injury identified by single-balloon endoscopy or capsule endoscopy. Med Sci Monit, 2017, 23: 5237-5245.
18.	Sethi S, Cohen J, Thaker AM, et al. Prior capsule endoscopy improves the diagnostic and therapeutic yield of single-balloon enteroscopy. Dig Dis Sci, 2014, 59(10): 2497-2502.
19.	Ooka S, Kobayashi K, Kawagishi K, et al. Roles of capsule endoscopy and single-balloon enteroscopy in diagnosing unexplained gastrointestinal bleeding. Clin Endosc, 2016, 49(1): 56-60.
20.	Shishido T, Oka S, Tanaka S, et al. Diagnostic yield of capsule endoscopy vs. double-balloon endoscopy for patients who have undergone total enteroscopy with obscure gastrointestinal bleeding. Hepatogastroenterology, 2012, 59(116): 955-959.
21.	Tenembaum D, Sison C, Rubin M. Accuracy of community based video capsule endoscopy in patients undergoing follow up double balloon enteroscopy. World J Gastrointest Endosc, 2013, 5(4): 154-159.
22.	Tian Min C, Li Hua X, Ying Lin J, et al. The role of double-balloon enteroscopy following capsule endoscopy in diagnosis of obscure small intestinal diseases. Pak J Med Sci, 2013, 29(2): 479-484.
23.	Zhang ZH, Qiu CH, Li Y. Different roles of capsule endoscopy and double-balloon enteroscopy in obscure small intestinal diseases. World J Gastroenterol, 2015, 21(23): 7297-7304.
24.	鐘穎, 張秋琴, 徐怡, 等. 氣囊輔助腸鏡檢查和膠囊內鏡檢查對于疑似小腸克羅恩病的診斷價值比較與分析. 貴州醫藥, 2019, 43(5): 803-804.
25.	趙偉, 杜志強, 羅山鋮, 等. 潛水法膠囊內鏡和雙氣囊小腸鏡對小腸疾病診斷價值比較. 醫藥前沿, 2018, 8(10): 189-190.
26.	Harbord M, Annese V, Vavricka SR, et al. The first European evidence-based consensus on extra-intestinal manifestations in inflammatory bowel disease. J Crohns Colitis, 2016, 10(3): 239-254.
27.	Pennazio M, Spada C, Eliakim R, et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy, 2015, 47(4): 352-376.
28.	Hara AK, Leighton JA, Heigh RI, et al. Crohn disease of the small bowel: preliminary comparison among CT enterography, capsule endoscopy, small-bowel follow-through, and ileoscopy. Radiology, 2006, 238(1): 128-134.
29.	Arroyo-Mercado FM, Martinez M. Asymptomatic tracheal aspiration of capsule endoscopy in a patient without dysphagia. ACG Case Rep J, 2019, 6(10): e00237.
30.	Li X, Dai J, Lu H, et al. A prospective study on evaluating the diagnostic yield of video capsule endoscopy followed by directed double-balloon enteroscopy in patients with obscure gastrointestinal bleeding. Dig Dis Sci, 2010, 55(6): 1704-1710.
31.	Domagk D, Mensink P, Aktas H, et al. Single- vs. double-balloon enteroscopy in small-bowel diagnostics: a randomized multicenter trial. Endoscopy, 2011, 43(6): 472-476.
32.	Brito HP, Ribeiro IB, de Moura DTH, et al. Video capsule endoscopy vs double-balloon enteroscopy in the diagnosis of small bowel bleeding: a systematic review and meta-analysis. World J Gastrointest Endosc, 2018, 10(12): 400-421.
33.	許春梅, 高云杰, 薛寒冰, 等. 膠囊內鏡對小腸憩室的診斷價值. 胃腸病學, 2014, 19(10): 603-605.
34.	He Q, Zhang YL, Xiao B, et a1. Double-balloon enteroseopy for diagnosis of Meckel’S diverticulum: comparison with operative findings and capsule endoscopy. Surgery, 2013, 153(4): 549-554.
35.	Cangemi DJ, Patel MK, Gomez V, et al. Small bowel tumors discovered during double-balloon enteroscopy: analysis of a large prospectively collected single-center database. J Clin Gastroenterol, 2013, 47(9): 769-772.
36.	Patel MK, Horsley-Silva JL, Gómez V, et al. Double balloon enteroscopy procedure in patients with surgically altered bowel anatomy: analysis of a large prospectively collected database. J Laparoendosc Adv Surg Tech A, 2013, 23(5): 409-413.
37.	鐘捷, 張晨莉, 金承榮, 等. 小腸腫瘤診斷: 雙氣囊小腸鏡與其他檢查手段的對比研究. 中華消化雜志, 2006, 26: 579-581.
38.	Sheba E, Farag A, Aref W, et al. Double-balloon enteroscopy (DBE) in patients presenting with obscure gastrointestinal bleeding (OGIB). Arab J Gastroenterol, 2017, 18(4): 228-233.
39.	Gerson LB, Fidler JL, Cave DR, et al. ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding. Am J Gastroenterol, 2015, 110(9): 1265-1287.

1. Swain P, Adler D, Enns R. Capsule endoscopy in obscure intestinal bleeding. Endoscopy, 2005, 37(7): 655-659.
2. Kahn E, Daum F. Anatomy, histology, embryology, and developmental anomalies of the small and large intestine. Available from: https://clinicalgate.com/anatomy-histology-embryology-and-developmental-anomalies-of-the-small-and-large-intestine/.
3. Leighton JA, Wallace MB. Update on small bowel imaging. Gastroenterology, 2007, 132(5): 1651-1654.
4. Gurudu SR, Vargas HE, Leighton JA. New frontiers in small-bowel imaging: the expanding technology of capsule endoscopy and its impact in clinical gastroenterology. Rev Gastroenterol Disord, 2008, 8(1): 1-14.
5. 鄔蘭, 張永, 曾憲濤. QUADAS-2 在診斷準確性研究的質量評價工具中的應用. 湖北醫藥學院學報, 2013, 32(3): 201-208.
6. Shiani A, Nieves J, Lipka S, et al. Degree of concordance between single balloon enteroscopy and capsule endoscopy for obscure gastrointestinal bleeding after an initial positive capsule endoscopy finding. Therap Adv Gastroenterol, 2016, 9(1): 13-18.
7. 曹燕洪, 王學紅. 雙氣囊小腸鏡和膠囊內鏡對不明原因慢性腹痛診斷價值的比較. 中國醫藥導刊, 2019, 21(5): 278-281.
8. Danialifar TF, Naon H, Liu QY. Comparison of diagnostic accuracy and concordance of video capsule endoscopy and double balloon enteroscopy in Children. J Pediatr Gastroenterol Nutr, 2016, 62(6): 824-827.
9. Hermans C, Stronkhorst A, Tjhie-Wensing A, et al. Double-balloon endoscopy in overt and occult small bowel bleeding: results, complications, and correlation with prior video capsule endoscopy in a tertiary referral center. Clin Endosc, 2017, 50(1): 69-75.
10. 何瓊. 雙氣囊小腸鏡(DBE)和膠囊內鏡(CE)對可疑小腸疾病診斷價值研究. 南京: 南京醫科大學, 2013.
11. Kalra AS, Walker AJ, Benson ME, et al. Comparison of capsule endoscopy findings to subsequent double balloon enteroscopy: a dual center experience. Diagn Ther Endosc, 2015, 2015: 438757.
12. Otani K, Watanabe T, Shimada S, et al. Usefulness of small bowel reexamination in obscure gastrointestinal bleeding patients with negative capsule endoscopy findings: comparison of repeat capsule endoscopy and double-balloon enteroscopy. United European Gastroenterol J, 2018, 6(6): 879-887.
13. 李江波, 孫聰, 王玲玲, 等. 膠囊內鏡與雙氣囊小腸鏡在小腸疾病診斷中的價值初探. 中國藥物與臨床, 2020, 20(1): 61-63.
14. Ma JJ, Wang Y, Xu XM, et al. Capsule endoscopy and single-balloon enteroscopy in small bowel diseases: competing or complementary? World J Gastroenterol, 2016, 22(48): 10625-10630.
15. Marmo R, Rotondano G, Casetti T, et al. Degree of concordance between double-balloon enteroscopy and capsule endoscopy in obscure gastrointestinal bleeding: a multicenter study. Endoscopy, 2009, 41(7): 587-592.
16. 毛乙鴻, 張燕, 吳俊超. 膠囊內鏡和單氣囊小腸鏡診斷價值的對比. 醫藥前沿, 2017, 7(32): 32-34.
17. Xu N, Yu Z, Cao X, et al. Characteristics of nonsteroidal anti-inflammatory drugs (NSAIDs)-induced small bowel injury identified by single-balloon endoscopy or capsule endoscopy. Med Sci Monit, 2017, 23: 5237-5245.
18. Sethi S, Cohen J, Thaker AM, et al. Prior capsule endoscopy improves the diagnostic and therapeutic yield of single-balloon enteroscopy. Dig Dis Sci, 2014, 59(10): 2497-2502.
19. Ooka S, Kobayashi K, Kawagishi K, et al. Roles of capsule endoscopy and single-balloon enteroscopy in diagnosing unexplained gastrointestinal bleeding. Clin Endosc, 2016, 49(1): 56-60.
20. Shishido T, Oka S, Tanaka S, et al. Diagnostic yield of capsule endoscopy vs. double-balloon endoscopy for patients who have undergone total enteroscopy with obscure gastrointestinal bleeding. Hepatogastroenterology, 2012, 59(116): 955-959.
21. Tenembaum D, Sison C, Rubin M. Accuracy of community based video capsule endoscopy in patients undergoing follow up double balloon enteroscopy. World J Gastrointest Endosc, 2013, 5(4): 154-159.
22. Tian Min C, Li Hua X, Ying Lin J, et al. The role of double-balloon enteroscopy following capsule endoscopy in diagnosis of obscure small intestinal diseases. Pak J Med Sci, 2013, 29(2): 479-484.
23. Zhang ZH, Qiu CH, Li Y. Different roles of capsule endoscopy and double-balloon enteroscopy in obscure small intestinal diseases. World J Gastroenterol, 2015, 21(23): 7297-7304.
24. 鐘穎, 張秋琴, 徐怡, 等. 氣囊輔助腸鏡檢查和膠囊內鏡檢查對于疑似小腸克羅恩病的診斷價值比較與分析. 貴州醫藥, 2019, 43(5): 803-804.
25. 趙偉, 杜志強, 羅山鋮, 等. 潛水法膠囊內鏡和雙氣囊小腸鏡對小腸疾病診斷價值比較. 醫藥前沿, 2018, 8(10): 189-190.
26. Harbord M, Annese V, Vavricka SR, et al. The first European evidence-based consensus on extra-intestinal manifestations in inflammatory bowel disease. J Crohns Colitis, 2016, 10(3): 239-254.
27. Pennazio M, Spada C, Eliakim R, et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy, 2015, 47(4): 352-376.
28. Hara AK, Leighton JA, Heigh RI, et al. Crohn disease of the small bowel: preliminary comparison among CT enterography, capsule endoscopy, small-bowel follow-through, and ileoscopy. Radiology, 2006, 238(1): 128-134.
29. Arroyo-Mercado FM, Martinez M. Asymptomatic tracheal aspiration of capsule endoscopy in a patient without dysphagia. ACG Case Rep J, 2019, 6(10): e00237.
30. Li X, Dai J, Lu H, et al. A prospective study on evaluating the diagnostic yield of video capsule endoscopy followed by directed double-balloon enteroscopy in patients with obscure gastrointestinal bleeding. Dig Dis Sci, 2010, 55(6): 1704-1710.
31. Domagk D, Mensink P, Aktas H, et al. Single- vs. double-balloon enteroscopy in small-bowel diagnostics: a randomized multicenter trial. Endoscopy, 2011, 43(6): 472-476.
32. Brito HP, Ribeiro IB, de Moura DTH, et al. Video capsule endoscopy vs double-balloon enteroscopy in the diagnosis of small bowel bleeding: a systematic review and meta-analysis. World J Gastrointest Endosc, 2018, 10(12): 400-421.
33. 許春梅, 高云杰, 薛寒冰, 等. 膠囊內鏡對小腸憩室的診斷價值. 胃腸病學, 2014, 19(10): 603-605.
34. He Q, Zhang YL, Xiao B, et a1. Double-balloon enteroseopy for diagnosis of Meckel’S diverticulum: comparison with operative findings and capsule endoscopy. Surgery, 2013, 153(4): 549-554.
35. Cangemi DJ, Patel MK, Gomez V, et al. Small bowel tumors discovered during double-balloon enteroscopy: analysis of a large prospectively collected single-center database. J Clin Gastroenterol, 2013, 47(9): 769-772.
36. Patel MK, Horsley-Silva JL, Gómez V, et al. Double balloon enteroscopy procedure in patients with surgically altered bowel anatomy: analysis of a large prospectively collected database. J Laparoendosc Adv Surg Tech A, 2013, 23(5): 409-413.
37. 鐘捷, 張晨莉, 金承榮, 等. 小腸腫瘤診斷: 雙氣囊小腸鏡與其他檢查手段的對比研究. 中華消化雜志, 2006, 26: 579-581.
38. Sheba E, Farag A, Aref W, et al. Double-balloon enteroscopy (DBE) in patients presenting with obscure gastrointestinal bleeding (OGIB). Arab J Gastroenterol, 2017, 18(4): 228-233.
39. Gerson LB, Fidler JL, Cave DR, et al. ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding. Am J Gastroenterol, 2015, 110(9): 1265-1287.

Chinese Journal of Evidence-Based Medicine

Diagnostic value of capsule endoscopy and enteroscopy in small bowel diseases: a meta-analysis

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