[Diagnostic effectiveness, security and clinical usefulness of capsule endoscopy in the diagnosis of small bowel disorders]
Varela Lema L, Ruano-Ravina A
Record ID 32006000189
The main objective was to compare and evaluate, in view of the existing evidence, the effectiveness and safety of capsule endoscopy versus other conventional imaging methods in the diagnosis of small bowel disorders. This report also aimed to establish the subgroup of patients that can mostly benefit from endoscopic capsule use.
Authors' results and conclusions:
The systematic review included 28 original articles that assessed the use of endoscopic capsule in small bowel disorders: obscure digestive tract bleeding (12), Crohn's disease (10), celiac disease (1), hereditary intestinal polyposis syndromes (4), abdominal pain (1), other indications (2). The diagnostic yield of endoscopic capsule in obscure digestive tract bleeding ranged from 40.9%-77.3%. Push enteroscopy had values lower than 40% in all but one of the studies. The S, E, PPV and NPV in the only study that used intraoperative enteroscopy as a reference standard was 95%, 75%, 95% and 86%.
Capsule endoscopy detected lesions in 19-71% of the patients with suspicion of small bowel Crohn's disease, whilst radiological images (barium follow through and enteroclysis) detected lesions in 0-37% of the subjects. These same values for patients with suspicion of recurrence were 66.6%-81% and 19%-49%, respectively. In pediatric patients suspected to have Crohn's disease these values were 58.3%-60% and 0-20%. The only study that provided results of diagnostic efficiency for suspicion of Crohn's disease using ileocolonoscopy with biopsy as the reference standar found that the S, E, PPV, NPV was 89.6%, 100%, 100%, 76.9% for endoscopic capsule and 27.6%, 100%, 100%, 23.3% for radiological procedures. Only one study assessed celiac disease. The S, E, PPV, NPV was 70%, 100%, 100% and 70%, respectively. CE detected additional small polyps in the distal jejunum and ileum in comparisson to push enteroscopy, magnetic resonance and small bowel radiography in four of the studies included.
The evidence available shows that endoscopic capsule is a safe and effective diagnostic procedure for the detection of obscure digestive tract bleeding. Endoscopic capsule has a higher diagnostic than push enteroscopy and other conventional methods. The results suggest that it is superior to conventional radiological procedures in the detection of lesions in patients with Crohn's disease. The high number of patients with strictures limits its use as a first line diagnostic test in patients previously diagnosed. There are slight indications that endoscopic capsule can be useful in pediatric patients with suspicion of Crohn's disease. At this moment there is no evidence to justify its use in patients with familial adenomatous polyposis but the results suggest that it could be useful in patients with Peutz-Jeghers syndrome.There is no evidence or it is insufficient to determine endoscopic capsule performance in the other diseases under study: celiac disease, irritable bowel syndrome, small bowel neoplasms, chronic diarrhea and abdominal pain.
English language abstract:
An English language summary is available
- Crohn Disease
- Endoscopy, Gastrointestinal
- Intestine, Small
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