| Aim: Located in the middle part of the digestive tract,the small intestine is the longest section of the digestive tract,and the average length of adult is 5-7 meters.Because of its special anatomical position and structural characteristics,it is difficult to make effective diagnosis and treatment of small intestinal diseases.In recent years,with the development and popularization of capsule endoscopy and double-balloon or single-balloon enteroscopy,the detection rate of small bowel diseases has been greatly improved.Capsule endoscopy can show the pathological changes in the small intestine,and has the advantages of painless,safe.The observation of the pathological changes of the balloon enteroscopyc is more clear,and can be taken biopsy and endoscopic treatment.However,balloon enteroscopy need to be combined the two insertion approaches to observe the entire small intestine.At present,capsule endoscopy and balloon enteroscopy in the diagnosis of small bowel diseases have a good effect,but the two have their own advantages and disadvantages.In recent years,many scholars have studied on the detection rate of small intestinal diseases by these two methods,but the results are not consistent.In this paper,we analyzed the diagnosis of small bowel diseases by capsule endoscopy and balloon enteroscopy since 2002-2016.To compare the diagnosis value of capsule endoscopy versus balloon enteroscopy in small bowel diseases to help choose the optimal diagnostic stratrgy for this clinical condition.Methods: A comprehensive literature search was performed in Pubmed,Embase,Cochrane Library and China National Knowledge Infrastructure database(CNKI)of prospective or retrospective studies using capsule endoscopy and balloon enteroscopy for the diagnosis of small bowel diseases.Inclusion criteria are as follows:(1)The selected literature was published in both domestic and international journals,including prospective or retrospective studies(full text or abstract).(2)All cases were confirmed by gastroscopy,colonoscopy and other traditional examination of the exclusion of other diseases suspected small bowel diseases.(3)In each study,the patients were required to perform capsule endoscopy and balloon endoscopy,that is,the two tests were performed in the same patient to compare the two methods under the same conditions.Revman 5.3 software was used for Meta-analysis.Outcome measure was odds ratio(OR)of the yield.Random effect model method was used for data analysis after Heterogeneity test.Results: Based on inclusion criteria,29 studies were included in this study,including 2256 patients.A total of 1422 lesions were detected by capsule endoscopy,and a total of 1398 lesions were detected by balloon enteroscopy.Meta-analysis showed no significant difference in the diagnostic rate between capsule endoscopy and balloon enteroscopy in small bowel diseases(random effect model,OR=1.13,95% CI:0.91-1.41,P=0.27).Because of a part of patients with abdominal pain and diarrhea may be functional gastrointestinal diseases,they will affect the diagnosis rate of capsule endoscopy and balloon enteroscopy,so we carried on a subgroup analysis.Subgroup analysis showed that the diagnostic rate had no significant difference between capsule endoscopy and balloon enteroscopy in obscure gastrointestinal bleeding(random effect model,OR=1.08,95% CI:0.75-1.54,P=0.68).Conclusion: Capsule endoscopy and balloon enteroscopy have similar diagnostic yields in patients with small bowel disease and OGIB.Capsule endoscopy can be used as the preferred examination method in patients with suspected small bowel disease.Based on the results of capsule endoscopy,the approach of balloon enteroscopy and further endoscopic treatment were determined.The diagnostic rate of balloon enteroscopy was higher than that of capsule endoscopy in some diseases,such as cancer,polyps and diverticulum.Balloon enteroscopy with biopsy,endoscopic therapy is the advantage of capsule endoscopy cannot be replaced.So balloon enteroscopy is often necessary after positive examination of capsule endoscopy. |
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