Comparison of the diagnostic yield of capusel endoscopy and double-balloon enteroscopy in small bowel disease

Objective: Examination of the whole small intestines has been challenging, due to its anatomical location in the middle of the digestive tract, structural features and physiological functions. Diagnosis and management of patients with small-intestinal disorders, has been revolutionized since advent of capsule endoscopy (CE) and double-balloon endoscopy (DBE) Currently, there is no consensus regarding clinical application of CE and DBE in the diagnosis and treatment of small intestinal disorders. While no definitive clinical standards exist, a common practice involves tailoring DBE approach (oral or rectal) based on CE findings. Although above protocol seems efficient approach,it's not clear whether the above protocol is a good choice for cost effectiveness. The aim of this study to conduct a comparative analysis of diagnostic yield and efficacy between capsule endoscopy (CE) and double-balloon enteroscopy (DBE) to determine optimal diagnostic approach. Materials and Methods: A retrospective analysis was conducted on 24 patients (7 females, 17 males)who underwent VCE followed by DBE procedures within 3 months in 2022. The study was ethically approved by the Yeditepe University Faculty of Medicine. To assess the diagnostic accuracy of VCE in identifying lesions relative to the gold standard DBE, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Furthermore, 95% confidence intervals were provided for each measure to enhance the interpretation and generalizability of the findings. Lesion detection rates between VCE and DBE were compared using McNemar's test for paired analysis. Results: The sensivity and specifity of VCE using DBE as the gold standart varied by lesion types. Overall, the sensivity of VCE was 85.7% and the specifity was 66.7%. VCE was most sensitive (100%) and spesific (91.3%) for small intestinal polyps. It was moderately sensitive (75%) but significantly spesific (87.5%) for angioectasia. VCE has considerably high sensitivity (80%) and specificity (89.5%) for ulcers. It is noteworthy that the both diverticular lesions identified by DBE were not detected by VCE. The positive and negative predictive value of VCE by lesion type were: Angioectasia 94.7% and 40% respectively; Ulcers&Erosions 66.7% and 94.4% respectively; Polyps 33.3% and 63.6% respectively; Diverticula not avaliable and 100% respectively. Conclusion: Our study, utilizing DBE as the gold standard, found that VCE demonstrated high sensitivity and specificity for diagnosing various small bowel diseases. However, VCE cannot be relied upon to rule out small bowel diverticula. Furthermore, our findings support the current clinical algorithm for managing obscure bleeding, which often recommends observation after a negative VCE.