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.	邬兰, 张永, 曾宪涛. QUADAS-2 在诊断准确性研究的质量评价工具中的应用. 湖北医药学院学报, 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, 王学红. 双气囊小肠镜和胶囊内镜对不明原因慢性腹痛诊断价值的比较. 中国医药导刊, 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.	何琼. 双气囊小肠镜(DBE)和胶囊内镜(CE)对可疑小肠疾病诊断价值研究. 南京: 南京医科大学, 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, 孙聪, 王玲玲, 等. 胶囊内镜与双气囊小肠镜在小肠疾病诊断中的价值初探. 中国药物与临床, 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.	毛乙鸿, 张燕, 吴俊超. 胶囊内镜和单气囊小肠镜诊断价值的对比. 医药前沿, 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.	钟颖, 张秋琴, 徐怡, 等. 气囊辅助肠镜检查和胶囊内镜检查对于疑似小肠克罗恩病的诊断价值比较与分析. 贵州医药, 2019, 43(5): 803-804.
25.	赵伟, 杜志强, 罗山铖, 等. 潜水法胶囊内镜和双气囊小肠镜对小肠疾病诊断价值比较. 医药前沿, 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.	许春梅, 高云杰, 薛寒冰, 等. 胶囊内镜对小肠憩室的诊断价值. 胃肠病学, 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.	钟捷, 张晨莉, 金承荣, 等. 小肠肿瘤诊断: 双气囊小肠镜与其他检查手段的对比研究. 中华消化杂志, 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. 邬兰, 张永, 曾宪涛. QUADAS-2 在诊断准确性研究的质量评价工具中的应用. 湖北医药学院学报, 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, 王学红. 双气囊小肠镜和胶囊内镜对不明原因慢性腹痛诊断价值的比较. 中国医药导刊, 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. 何琼. 双气囊小肠镜(DBE)和胶囊内镜(CE)对可疑小肠疾病诊断价值研究. 南京: 南京医科大学, 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, 孙聪, 王玲玲, 等. 胶囊内镜与双气囊小肠镜在小肠疾病诊断中的价值初探. 中国药物与临床, 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. 毛乙鸿, 张燕, 吴俊超. 胶囊内镜和单气囊小肠镜诊断价值的对比. 医药前沿, 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. 钟颖, 张秋琴, 徐怡, 等. 气囊辅助肠镜检查和胶囊内镜检查对于疑似小肠克罗恩病的诊断价值比较与分析. 贵州医药, 2019, 43(5): 803-804.
25. 赵伟, 杜志强, 罗山铖, 等. 潜水法胶囊内镜和双气囊小肠镜对小肠疾病诊断价值比较. 医药前沿, 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. 许春梅, 高云杰, 薛寒冰, 等. 胶囊内镜对小肠憩室的诊断价值. 胃肠病学, 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. 钟捷, 张晨莉, 金承荣, 等. 小肠肿瘤诊断: 双气囊小肠镜与其他检查手段的对比研究. 中华消化杂志, 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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