The Diagnostic Value Of Double-balloon Enteroscopy In Patients With Negative Computed Tomography Enterography Results

Objective To understand the diagnostic value of double-balloon enteroscopy(DBE)and computed tomography enterography(CTE)in small bowel diseases,and to explore the predictive factors of DBE positive results in patients with negative CTE results,so as to provide some reference for the selection of diagnostic methods for patients with suspected small bowel diseases in clinical practice.Methods A total of 1013 patients with suspected small bowel diseases who underwent CTE and DBE examinations admitted to the Department of Gastroenterology of the Department of Gastroenterology of the First Affiliated Hospital of Anhui Medical University from May 2018 to May 2022 were enrolled.The results of the two examination methods were collected and compared respectively in terms of their detection rate,diagnosis rate and diagnostic value for small bowel diseases.147 patients with negative CTE results were divided into DBE positive group and DBE negative group according to whether the DBE results were positive or not,of which 94 patients were in the DBE positive group and 53 patients were in the DBE negative group.The basic and general clinical data and laboratory indicators of patients in the two groups were collected and compared.The statistically significant diff erences were included in the multivariate binar y dependent variable logistic regression analysis to explore the predictive factors of DBE positive results in patients with negative CTE results.Results(1)Taking the results of DBE as the reference standard,the sensitivity of CTE was89.6%,the specificity was 49.1%,the positive predictive value was 93.6%,and the negative predictive value was 36.1%.(2)The main clinical symptoms of patients undergoing CTE and DBE examination were abdominal pain and unexplained gastrointestinal bleeding,accounting for 55.1%(558/1013)and 30.6%(310/1013)respectively.For patients with different clinical symptoms,the overall detection rate(89.5% vs 85.3%,P=0.004)and overall diagnosis rate(80.4% vs 58.2%,P<0.001)of DBE were higher than those of CTE.For patients with abdominal pain,the diagnostic rate of DBE examination was higher than that of CTE examination(P<0.001),but there was no significant statistical difference in the detection rate between the two.In patients with unexplained gastrointestinal bleeding,the detection rate(89.7% vs 78.7%,P<0.001)and diagnosis rate(88.4% vs 52.3%,P<0.001)of DBE were higher than those of CTE.For patients with diarrhea,nausea and vomiting or other symptoms,there was no significant difference in the detection rate and diagnosis rate of DBE and CTE.(3)The proportion of male,the proportion of patients under 60 years old,and the proportion of patients with unexplained gastrointestinal bleeding in the DBE-positive group were higher than those in the DBE-negative group(P<0.05).The hemoglobin level and albumin level in the DBE-positive group were lower than those in the DBE-negative group(P<0.05).The multivariate binary dependent variable logistic regression analysis showed that under 60 years old(OR=9.325,95%CI=2.534-34.318),anemia(OR=0.955,95% CI=0.921-0.991),and hypoalbuminemia(OR=0.894,95% CI=0.807-0.991)were predictive factors for the positive results of DBE in patients with negative CTE results(P<0.05).(4)Among the patients with negative CTE results and positive DBE results,intestinal inflammation,erosion and ulcerative lesions were the most common microscopic manifestations,accounting for 37.2%(35/94).The second was small intestinal vascular disease,accounting for 33.0%(31/94).Conclusion Compared with DBE,CTE is more likely to be false negative in the diagnosis of small bowel diseases,and it is easy to miss diagnosis.Among patients with negative CTE results,those with age <60 years,anemia,and hypoalbuminemia were more likely to have positive DBE results.CTE is poor in identifying small bowel mucosal lesions such as superficial ulcers,erosions,and vascular dysplasia.Therefore,when small bowel mucosal lesions and small bowel bleeding are suspected,if the CTE result is negative,further DBE examination should be performed to confirm the diagnosis.