Comparative Study Of Double-balloon Enteroscopy And Capsule Endoscopy In Diagnosis Of Obscure Gastrointestinal Bleeding

Background and ObjectiveThe small bowel (SB) is the longest organ in human body and traditional imaging techniques such as radiologic, endoscopic etc. could not get satisfied results for the diagnosis. So the confirmative diagnosis is difficult to achieve for SB diseases. Capsule endoscopy(CE) and double-balloon enteroscopy(DBE) are new methods of enteroscopy that have been introduced in recent years. They are epoch-making examination methods that make an endoscopic imaging examination of the entire SB possible in clinic. Obscure gastrointestinal bleeding (OGIB)always causes by jejunal and ileal lesions. Reports have been made on DBE and CE in patients with OGIB,but there are different conclusions in the reports. This study trys to evaluate the diagnostic yield and the etiological accuracy of DBE and CE in patients with OGIB.MethodsOne hundred and thirty-nine patients with OGIB had preceding upper gastrointestinal endoscopy and ileocolonoscopy, but no etiological causes of bleeding had be found. Seventy-three cases of patients(including 43 cases of men and 30 cases of women) were performed double balloon enteroscopy .The route of enteroscopy could be underwent either via mouth or via anus. Negative result of initial route was required afterwards for another via mouth or via anus examination. And sixty-six patients(including 23 cases of men and 43 cases of women) were performed capsule endoscopy. Among the cases, nineteen patients were performed both DBE and CE.Results1,Seventy-seven focus of infections were detected in DBE group. Mucosal breaks (erosions and ulcerations) ,angiodysplasia,diverticulum and polypus were detected in 28/73 (38.4%) , 12/73 (16.4%) , 10/73 (13.7%) and 7/73 (9.6%)patients,respectively. Seventy focus of infections were detected in CE group. Mucosal breaks (erosions and ulcerations) ,angiodysplasia,space occupying lesion,polypus and active bleeding were detected in 20/66 (30.3%) , 13/66 (19.7%),12/66 (18.2%) , 8/66 (12.1%) and 8/66 (12.1%) patients,respectively.2,The overall diagnostic yield for DBE group was 94.5%, and that for CE group was 81.8%. The etiological diagnostic accuracy of DBE group was 80.8%, and that for CE group was 50.0%.3,Nineteen patients were performed the combination of CE and DBE.Ten of them gain the same conclusion. Three cases of SB multiple ulcers, two cases of polypus ,one case of angiodysplasia, one case of venous aneurysm and one case of diverticulum were found additionally via DBE compared with via CE.4,The successful one-cheching rate was 77.8% and 78.9% in only performed DBE patients and performed both DBE and CE patients, respectively.5,The entire GI tract visiting rate was 23.3% and 95.5% in DBE and CE,respectively.6,Treatment was changed based on the results of DBE in 34 patients and the results of CE in 23 patients.7,The DBE group patients were well tolerated,and had no complication. The number of the CE group complication was 1 case.Conclusions1,The commonest causes of OGIB are SB mucosal breaks (erosions and ulcerations) and angiodysplasia.It is similar to relative reports.2,Double balloon enteroscopy was superior(P<0.05) to capsule endoscopy in the diagnostic yield and the etiological diagnosis of obscure gastrointestinal bleeding.3,DBE and CE are safty for patients, but CE is more convenient.