Multi-detector CT Enterography Versus Double-balloon Enteroscopy: Comparison Of The Diagnostic Value For Patients With Suspected Small Bowel Diseases

Aim: Small bowel diseases were important pathogenic factors causing abdominal symptoms. The diagnosis of small bowel diseases is of important value in clinical work. The retrospective study was to compare the diagnostic value of multi-detector CT enterography(MDCTE) and double-balloon enteroscopy(DBE) for patients with suspected small bowel diseases and to provide instructions for their application in clinical work.Methods: From January 2009 to January 2014, 190 patients with suspected small bowel diseases were included in this study. The patients were examined with MDCTE and DBE. The characteristics of the patients, the indications and conclusions of the procedures were collected. The detection rate, diagnostic yields, sensitivity, specificity, positive predictive value and negative predictive value were described, and the diagnostic value of MDCTE and DBE was analyzed.Results: The overall detection rate and overall diagnostic yield of DBE were higher than those of MDCTE(detection rate 92.6% vs. 55.8%, p<0.05, diagnostic yield 83.2% vs. 33.7%, p<0.05). For abdominal pain patients, the diagnostic yield of DBE was higher than MDCTE, but the detection rates were not statistically different(diagnostic yield 77.4% vs. 49.1%, p<0.05, detection rate 84.9% vs.69.8%, p=0.057). DBE had higher diagnostic yield and detection rate than MDCTE for obscure gastrointestinal bleeding(OGIB) patients(detection rate 100.0% vs.47.3%, p<0.05, diagnostic yield 87.3% vs. 20.9%, p<0.05), while for patients with other indications, the differences of detection rate and diagnostic yield between the two examinations were not statistically significant(detection rate 77.8% vs. 63.0%, p=0.344, diagnostic yield 77.8% vs. 55.6%, p=0.146). For the diagnosis of different small bowel diseases, the diagnostic yields of DBE for inflammatory diseases, angioma/angiodysplasia and diverticulums were higher than that of MDCTE(90.2% vs. 25.0%, p<0.05,78.9% vs. 26.3%, p<0.05, 100.0% vs.12.5%, p<0.05). The difference of diagnostic yield between DBE and MDCTE was not statistically significant for gastrointestinal tumors/polyps(75.6% vs. 56.1%, p=0.096). For Crohn's disease, the diagnostic yields and detection rates of DBE and MDCTE were not statistically different(detection rate 100.0% vs. 72.7%, p=0.25, diagnostic yield 36.4% vs.18.2%, p=0.625). The sensitivity, specificity, positive predictive value and negative predictive value of DBE for suspected small bowel diseases were all higher than those of MDCTE.Conclusions: The diagnostic value of DBE for small bowel diseases is better than that of MDCTE as a whole. Compared with MDCTE, DBE is better at detecting lesions for OGIB patients, and better at diagnosing diseases for abdominal pain patients and OGIB patients. DBE have better diagnostic value than MDCTE in diagnosing inflammatory diseases, angioma/angiodysplasia and diverticulums. When diagnosing gastrointestinal tumors, the diagnostic value of DBE and MDCTE are well-matched, and we recommend combining them to obtain a comprehensive and accurate diagnosis if necessary. Both MDCTE and DBE have limited diagnostic value for Crohn's disease, and endoscopic biopsy by DBE is usually the first choice for its diagnosing in clinical work.