Gadour Eyad, Miutescu Bogdan, Okasha Hussein Hassan, Ghiuchici Ana Maria, AlQahtani Mohammed S
Multiorgan Transplant Centre of Excellence, Liver Transplantation Unit, King Fahad Specialist Hospital, Dammam 32253, Saudi Arabia.
Internal Medicine, Faculty of Medicine, Zamzam University College, Khartoum 11113, Sudan.
World J Gastrointest Endosc. 2025 Jul 16;17(7):108264. doi: 10.4253/wjge.v17.i7.108264.
Small-bowel disorders, including obscure gastrointestinal bleeding (OGIB), Crohn's disease, and tumors, require accurate diagnostic approaches for effective treatment. Video capsule endoscopy (VCE) and simple balloon enteroscopy (SBE) are widely used; however, each modality has limitations, particularly regarding therapeutic intervention and diagnostic yield.
To evaluate diagnostic yields of various modalities for small bowel bleeding, analyze factors affecting heterogeneity, and improve understanding of clinical outcomes associated with different diagnostic approaches.
A comprehensive search of four databases (PubMed, Embase, Cochrane Library, and Scopus) revealed over 600 citations related to the use of capsule endoscopy and balloon enteroscopy for diagnosing small intestine disorders with wall thickening. Based on predetermined eligibility criteria, seven moderate-to-high-quality retrospective studies were analyzed to evaluate the diagnostic performance of VCE and SBE in patients with small bowel disorders. Quality Assessment of Diagnostic Accuracy Studies was applied to evaluate the risk of bias and overall methodological quality.
Analysis of seven moderate-to-high-quality retrospective studies revealed comparable overall detection rates for small bowel lesions between VCE and SBE. VCE demonstrated superior performance in detecting vascular lesions. Conversely, SBE exhibited a higher efficacy in detecting ulcerative lesions. The overall diagnostic yield varied across studies, with VCE showing a range of 32%-83% for small bowel bleeding, whereas SBE demonstrated a higher overall detection rate of 69.7% compared to 57.6% for VCE ( < 0.05). Notably, SBE showed superior performance in diagnosing Crohn's disease, with a detection rate of 35%, compared to 11.3% for VCE ( < 0.001). The diagnostic concordance between VCE and SBE was influenced by the lesion type. Strong agreement was observed for inflammatory lesions (κ = 0.82, 95%CI: 0.75-0.89), whereas moderate agreement was noted for tumors (κ = 0.61, 95%CI: 0.52-0.70) and angiectasias (κ = 0.58, 95%CI: 0.49-0.67). SBE demonstrated significant advantages in therapeutic interventions, particularly in overt bleeding. Patient tolerability was generally higher for VCE, with a completion rate of 95% (95%CI: 92%-98%), compared to 85% for SBE (95%CI: 80%-90%). However, the capsule retention rate for VCE was 1.4% (95%CI: 0.8%-2.0%), necessitating subsequent intervention.
VCE and SBE are complementary techniques for evaluating small intestinal disorders. Although VCE remains the initial test of choice for patients with stable OGIB, SBE should be considered in patients requiring therapeutic intervention. Thus, combining both modalities enhances diagnostic accuracy and patient management.
小肠疾病，包括不明原因的胃肠道出血（OGIB）、克罗恩病和肿瘤，需要准确的诊断方法以进行有效治疗。视频胶囊内镜检查（VCE）和单气囊小肠镜检查（SBE）被广泛应用；然而，每种检查方式都有局限性，尤其是在治疗干预和诊断率方面。
评估各种检查方式对小肠出血的诊断率，分析影响异质性的因素，并增进对不同诊断方法相关临床结果的理解。
对四个数据库（PubMed、Embase、Cochrane图书馆和Scopus）进行全面检索，发现600多篇与使用胶囊内镜和小肠镜诊断小肠壁增厚性疾病相关的文献。根据预先确定的纳入标准，分析了七项中高质量的回顾性研究，以评估VCE和SBE在小肠疾病患者中的诊断性能。应用诊断准确性研究的质量评估来评估偏倚风险和整体方法学质量。
对七项中高质量回顾性研究的分析显示，VCE和SBE对小肠病变的总体检出率相当。VCE在检测血管病变方面表现更优。相反，SBE在检测溃疡性病变方面疗效更高。各项研究的总体诊断率有所不同，VCE对小肠出血的检出率在32%至83%之间，而SBE的总体检出率更高，为69.7%，VCE为57.6%（P<0.05）。值得注意的是，SBE在诊断克罗恩病方面表现更优，检出率为35%，而VCE为11.3%（P<0.001）。VCE和SBE之间的诊断一致性受病变类型影响。炎症性病变的一致性较强（κ = 0.82，95%CI：0.75 - 0.89），而肿瘤（κ = 0.61，95%CI：0.52 - 0.70）和血管扩张（κ = 0.58，95%CI：0.49 - 0.67）的一致性为中等。SBE在治疗干预方面具有显著优势，尤其是在显性出血方面。VCE的患者耐受性通常更高，完成率为95%（95%CI：92% - 98%），而SBE为85%（95%CI：80% - 90%）。然而，VCE的胶囊滞留率为1.4%（95%CI：0.8% - 2.0%），需要后续干预。
VCE和SBE是评估小肠疾病的互补技术。虽然VCE仍然是稳定型OGIB患者的首选初始检查，但对于需要治疗干预的患者应考虑SBE。因此，联合使用这两种检查方式可提高诊断准确性和患者管理水平。
