The Diagnostic Value Of Capsule Endoscopy And Double-balloon Enteroscopy For Obscure Gastrointestinal Bleeding:A Meta-analysis

Objective:To compare the diagnostic value of capsule endoscopy(CE)and double balloon enteroscopy(DBE)in the diagnosis of obscure gastrointestinal bleeding(OGIB),and to explore the optimal diagnosis and treatment plan for OGIB.Methods:According to the search strategy,the literature was searched in Chinese and English databases such as PubMEd,EMbase,Web of Science,Cochrane and Wanfang,CNKI,and Weipu.Using the combination of MeSH headings and Entry Terms,from January 1,2003 to December 31,2018.Find all the patients with OGIB who was performed of comparative studies using both CE and DBE.The literature obtained by the search was independently processed by the two investigators based on the inclusion and exclusion criteria.From the final included literature,the publication time,author,title,total sample size,sex ratio,mean age,diagnostic yields of CE and DBE were extracted.At the same time,the diagnostic yields of Vascular lesion,Ulcerative lesion and Tumor in the examination of CE and DBE were also included.META analysis was performed by Revman 5.3(Review Manager 5.3).The odds ratio(OR)was selected by random effect model,Mantel-Haenszel method,95%confidence interval(95%CI)and displayed with a forest map.Subgroup analysis included a comparison of the diagnostic yields of"ulcer","tumor",and"vascular dysplasia."The heterogeneity judgment refers to the I~2 value,the risk of bias is evaluated by a funnel chart,and the quality evaluation uses the QUADAS-2 tool.Result:A total of 1158 subjects were enrolled in 15 studies,including a minimum age of14 years and a maximum age of 92 years.Among the OGIB patients,713 were positive for CE and 694 were positive for DBE.The OR value of the diagnostic yieds of DBE compared with CE was 1.08(random effect model,95%CI:0.85-1.35,P=0.12,I~2=31%);in the comparison of CE and DBE in the examination of vascular dysplasia,840 patients were included.There were 323 positive cases in CE and 315cases in DBE.The OR value was 1.12(random effect model,95%CI:0.85-1.46,P=0.28,I~2=17%);714 patients were included in the comparison of tumor examinations.There were 59 cases with positive CE examination and 66 cases with positive DBE examination.The OR value was 0.92(random effect model,95%CI:0.62-1.34,P=0.74,I~2=0);794 patients were included in the comparison for examination of ulcers.There were 84 cases of CE positive cases and 74 cases of DBE positive cases.The OR value was 1.09(random effect model,95%CI:0.66-1.79,P=0.17,I~2=30%);the differences between the groups were not statistically significant.Conclusion:CE and DBE did not have statistically significant differences in the diagnostic yields of OGIB,on single examination CE is better.There was no statistically significant difference in the diagnostic yields of vascular dysplasia,tumors,and ulcers.After positive detection of CE the diagnostic yields of DBE has been improved,which can guide its perfect examination.CE can be used as the first choice for cases of OGIB.DBE is the preferred method for tissue biopsy and treatment of bleeding,and the two complement each other.