Complimentary Imaging Modalities For Investigating Obscure Gastrointestinal Bleeding:Capsule Endoscopy,Double-balloon Enteroscopy,and CT Enterography

Purpose This study is aimed at investigating the use of capsule endoscopy(CE) in the diagnosis of small bowel diseases, and the complementary value of CE combined with computed tomographic enterography(CTE) and/or double-balloon enteroscopy(DBE) in obscure gastrointestinal bleeding(OGIB). Methods Clinical information of 1475 patients who underwent OMOM and PillCam CE examinations in the endoscopy center of Ruijin hospital between July 2007 and July 2014 was collected and recorded in Excel database, which was then exported to SPSS 17.0 database for statistical analysis. We investigated the diagnostic value and safety of CE, and the correlation between its diagnostic yield of small bowel diseases and clinical characteristics of the subjects. We also included 121 patients who underwent DBE and/or CTE combined with CE with the indication of OGIB, and compared the complementary value of the three approaches. Results Our results suggested that the OMOM capsule device showed significantly prolonged small-bowel transit time(P<0.001) and lower overall diagnostic yield(P=0.001) compared with the PillCam capsule. The overall diagnostic yield of CE was 55.2%. Incomplete intestinal examination rate was 21.5%, and capsule retention rate was 0.5%. GI transit time of the capsule was associated with sex, age and type of small bowel diseases. Logistic regression analysis showed that the detection rates of angiodysplasia and Crohn’s disease(CD) were correlated with GI bleeding, abdominal pain, and age of subjects, and the detection rate of small bowel tumor(SBT) was correlated with GI bleeding.In the comparison of CE, CTE and DBE, statistical analysis showed that the diagnostic yield of CE was significantly higher than CTE(P<0.001), but no significant difference was found between CE and DBE. Analysis of the sub-groups showed that the diagnostic yield of angiodysplasia was significantly higher at CE, compared with CTE(P<0.001) and DBE(P=0.007), but no significant difference was found in the diagnosis of SBT between the three examinations. DBE and CTE identified small bowel diseases undetected or undetermined by CE. Conversely, CE improved diagnosis in the cases with negative CTE and DBE, and positive findings at initial CE directed further diagnosis made by DBE. Conclusions CE is a relatively safe and noninvasive examination of the small bowel with high sensitivity. It is especially useful in the localization of GI bleeding. Combination of CE, CTE and DBE in a properly integrated manner based on individual patient conditions provides complementary value in the diagnosis of OGIB.