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News

Capsule endoscopy superior to push enteroscopy in GI bleeds

Capsule endoscopy is superior to push enteroscopy and small bowel barium radiography for diagnosing clinically significant small bowel pathology in gastrointestinal bleeding, reports November's American Journal of Gastroenterology.

News image

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Capsule endoscopy has a superior ability to examine the entire small bowel mucosa.

Therefore, it has broadened the diagnostic evaluation of patients with obscure gastrointestinal bleeding.

Published studies have revealed a numerically superior performance of capsule endoscopy.

Capsule endoscopy has a superior performance in determining a source of obscure gastrointestinal bleeding compared with other modalities.

However, due to small sample sizes, the overall magnitude of benefit is unknown.

Additionally, the types of lesions more likely to be found by capsule endoscopy versus alternate modalities are also unknown.

Dr Sharma Virender and colleagues evaluated the yield of small bowel findings with capsule endoscopy in obscure gastrointestinal bleeding.

The researchers compared these findings to other modalities using meta-analysis.

The research team performed a recursive literature search of prospective studies.

Incremental yield of capsule endoscopy for clinically significant findings is 30% with a number needed to treat of 3
American Journal of Gastroenterology

The studies included in the analysis compared the yield of capsule endoscopy to other modalities for obscure gastrointestinal bleeding.

Data on yield and types of lesions identified among various modalities were extracted, pooled, and analyzed.

The team calculated incremental yield and 95% confidence intervals of capsule endoscopy over comparative modalities.

A total of 14 studies with 396 participants compared the yield of capsule endoscopy with push enteroscopy for obscure gastrointestinal bleeding.

The researchers found that the yield for capsule endoscopy and push enteroscopy was 63% and 28%, respectively.

The yield for capsule endoscopy and push enteroscopy with clinically significant findings in 379 participants was 56% and 26%, respectively.

The team noted 3 studies with 88 participants that compared the yield of capsule endoscopy to small bowel barium radiography.

The yield for capsule endoscopy and small bowel barium radiography for any finding was 67% and 8%, respectively.

For clinically significant findings, the yield for capsule endoscopy and small bowel barium radiography for any finding was 42% and 6%, respectively.

The research team observed that the number needed to test to yield 1 additional clinically significant finding with capsule endoscopy over either modality was 3.

The team found the studies compared the yield of significant findings on capsule endoscopy to intraoperative enteroscopy, and computed tomography enteroclysis.

These studies also compared the yield of findings on capsule endoscopy to mesenteric angiogram, and small bowel magnetic resonance imaging.

The researchers noted that 10 of the 14 trials comparing capsule endoscopy with push enteroscopy classified the types of lesions found on examination.

Capsule endoscopy had a 36% yield for vascular lesions versus 20% for push enteroscopy, with an incremental yield of 16%.

The team observed inflammatory lesions in 11% with capsule endoscopy vs 2% with push enteroscopy, with an incremental yield of 9%.

There was no significant difference in the yield of tumors or ‘other' findings between capsule endoscopy and push enteroscopy.

Dr Virender's team concludes, “Capsule endoscopy is superior to push enteroscopy and small bowel barium radiography for diagnosing clinically significant small bowel pathology in patients with obscure gastrointestinal bleeding.”

“In study populations, the incremental yield of capsule endoscopy over push enteroscopy and small bowel barium radiography for clinically significant findings is 30% with a number needed to treat of 3.”

“This is primarily due to visualization of additional vascular and inflammatory lesions by capsule endoscopy.”

Am J Gastroenterol 2005: 100(11): 2407
01 November 2005

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