BACKGROUND: Video capsule endoscopy (VCE) is an attractive and patient friendly tool that provides high quality images of the small bowel. The reported yield of VCE in diagnosing celiac disease (CD) has shown variable results.
OBJECTIVE: The aim of this study was to assess the accuracy of VCE by pooling data of existing trials.
DESIGN: Meta-analysis. The fixed-effects or random-effects model was used as appropriate, based on whether homogeneity or heterogeneity, respectively, was indicated by the Cochran Q-test.
PATIENTS: Studies that estimated the accuracy of VCE were identified. The two investigators independently conducted the search and data extraction. A total of 166 individuals were included in this meta-analysis.
METHODS: An extensive literature search was performed and studies that estimated the accuracy of VCE in CD were identified. The two investigators independently conducted the search and data extraction. Data from the eligible studies were collected and pooled; sensitivity, specificity, likelihood ratios, and diagnostic odds ratios were computed. In addition, the results of the individual studies were displayed in a receiver operating characteristic (ROC) space to illustrate the distribution of sensitivities and specificities. A weighted symmetric summary ROC curve was computed and the area under the curve (AUC) was calculated, with perfect tests having an AUC of 1 and poor tests having an AUC close to 0.5.
RESULTS: Out of 461 titles initially generated by the literature searches, six studies met the inclusion criteria and were eligible for meta-analysis. The overall pooled VCE sensitivity was 89% [95% confidence interval (82-94%)] and specificity was 95% [95% confidence interval (89-98%)]. The AUC under the weighted symmetric summary ROC was 0.9584.
CONCLUSION: The results of this meta-analysis mean that VCE, although it is not as accurate as pathology, could be a reasonable alternative method of diagnosing CD. Hopefully, this method will expand the portfolio of diagnostic methods available, especially in patients unwilling to undergo gastroscopy because of its perceived inconvenience and discomfort. However, larger, multicenter, and well-designed trials are needed to further establish the role of VCE in the diagnosis of CD.
BACKGROUND & AIMS: To further our understanding of capsule endoscopy (CE) in children, we systematically compiled data on indications and outcomes and evaluated the effectiveness of CE on patient management using meta-analyses.
METHODS: We searched the Medline and PubMed databases (January 2001-May 2010) for English language citations of use of CE in patients ≤18 years old. Duplicate reports and those that included 5 patients or fewer were removed. We analyzed data from 15 source documents with 740 CE procedures in 723 patients.
RESULTS: Suspicion or evaluation of inflammatory bowel diseases was the most common indication for CE (54%: 34% for patients suspected to have Crohn's disease [CD], 16% for patients known to have CD, 1% for patients with ulcerative colitis, and 3% for patients with indeterminate colitis). Completion and retention rates were 86.2% (95% confidence interval [CI], 81.5-90.3) and 2.6% (95% CI, 1.5-4.0), respectively. Retention rates for children that underwent gastric (0.5%) or small bowel (1.9%) CE were similar to those of adults, by indication. For CE, 65.4% of procedures resulted in positive findings (95% CI, 54.8-75.2). Where reported, 69.4% of CE examinations (95% CI, 46.9-87.9) resulted in a new diagnosis and 68.3% (95% CI, 43.6-88.5) led to change in therapy.
CONCLUSIONS: The relative frequency of CE indications varies among pediatric and adult patients. In pediatric patients, CE is used primarily to evaluate patients with CD - to aid in diagnosis, monitor disease severity, and assist patient management. Retention rates appear to be related to indication, rather than patient age; capsule retention is relatively infrequent for adults and children.
ACHTERGROND EN DOEL: Onzekerheid blijft over de beste test om patiënten met een obscure gastro-intestinale bloeding (OGIB) te evalueren. Vorige meta-analyses tonen een overeenkomstige diagnostische opbrengst met capsule endoscopie (CE) en dubbele ballon enteroscopy (DBE), maar zich primair op gegevens van samenvattingen en waren niet beperkt tot bloeden patiënten. Veel studies zijn inmiddels gepubliceerd. Daarom hebben we een nieuwe meta-analyse vergelijken van CE en DBE richtte zich specifiek op OGIB.
METHODEN: Een uitgebreide literatuurstudie werd uitgevoerd van vergelijkende studies met behulp van zowel CE en DBE bij patiënten met OGIB. De gegevens werden geëxtraheerd en geanalyseerd om de gewogen gepoolde diagnostische opbrengst van elke methode en de odds ratio voor de succesvolle lokalisatie van een bloeding bron te bepalen.
RESULTATEN: Tien in aanmerking komen studies werden geïdentificeerd. De gepoolde diagnostische opbrengst voor de CE was 62% (95% betrouwbaarheidsinterval [BI] 47.3 tot 76.1) en voor DBE was 56% (95% BI 48,9 tot 62.1), met een odds ratio voor de CE-in vergelijking met DBE van 1,39 (95% CI 0.88-2.20; P = 0,16). Subgroepen aangetoond opbrengst DBE uitgevoerd nadat een vooraf positieve CE was 75,0% (95% CI 60,1 tot 90,0) met de waarschijnlijkheidsverhouding voor succesvolle diagnose met DBE na een positieve CE opzichte DBE bij alle patiënten van 1,79 (95% CI 1.09-2.96, P = 0,02). In tegenstelling, de opbrengst DBE na een eerder negatieve CE slechts 27,5% (95% CI 16.7-37.8).
CONCLUSIES: Capsule endoscopie en dubbel ballon enteroscopy bieden soortgelijke diagnostische opbrengst bij patiënten met OGIB. De diagnostisch resultaat van DBE aanzienlijk hoger wanneer uitgevoerd bij patiënten met een positieve CE.
Objective To evaluate the CTE (including CT angiography method and CT intestinal bowel movement plethysmography), capsule endoscopy (CE), MR bowel movement plethysmography (MRE) and small bowel barium meal (SBFT) for Crohn's disease (CD) diagnostic accuracy degrees. PICO retrieval method follows the principle of Medline (1960 ~ 2010), PubMed, CBM, EMBASE, CCTR, Cochrane Library and other databases, combined with manual searches, included in the assessment or comparison CTE, CE, SBFT, MRE for Crohn's disease prospective or retrospective diagnostic tests. According to the quality of the literature included QUADAS quality evaluation criteria. The combined sensitivity of the detection method described above (SEN), merger specificity (SPE), the combined positive likelihood ratio (+ LR), the combined negative likelihood ratio (-LR) and the generality of the receiver operating characteristic curve (SROC) under the area. The results were included in the literature 9, a total of 360 cases. Reference standards include: ① endoscopy, pathology and imaging technology methods; ② ileocolonoscopy + surgery or biopsy results. There were four and five research ① and ② as the reference standard, the SEN were 0.77 (95% CI0.69 ~ 0.84), 0.86 (95% CI 0.80 ~ 0.90), SPE was 0.81 (95% CI 0.72 ~ 0.88), 0.97 (95% CI 0.89 ~ 1.00), + LR was 3.44 (95% CI1.61 ~ 7.32) 1,4.67 (95% CI 5.31 ~ 40.50), - LR was 0.30 (95% CI 0.18 ~ 0.50), 0.16 (95% CI 0.11 ~ 0.22), the area under the SROC curve was 0.8762 and 0.8429 respectively. CTE for Crohn's disease in which the sensitivity and specificity and the largest, followed for SBFT, MRE and CE. Conclusion In the comparison of four kinds of inspection techniques, CTE diagnosis of Crohn's disease most accurate.
DOELSTELLINGEN: Capsule endoscopie (CE) heeft aangetoond dat superieure prestaties in vergelijking met andere modaliteiten in zijn vermogen om de eerste dunne darm (SB) de ziekte van Crohn (CD) op te sporen, vooral wanneer ileoscopy negatief is of niet succesvol. Het doel van deze studie was om de diagnostische opbrengst van CE in vergelijking met andere modaliteiten bij patiënten met verdenking op en vestigde CD met behulp van een meta-analyse te evalueren. METHODEN: een grondige literatuurstudie voor toekomstige studies waarin de diagnostische opbrengst van CE met andere modaliteiten bij patiënten met een cd werd uitgevoerd. Andere modaliteiten opgenomen push enteroscopy (PE), colonoscopie met ileoscopy (C + IL), SB radiografie (SBR), computertomografie enterography (CTE), en magnetische resonantie enterography (MRE). De gegevens over de diagnostische opbrengst tussen de verschillende modaliteiten werden geëxtraheerd, samengevoegd en geanalyseerd. Gegevens over patiënten met verdenking op en gevestigde cd werden afzonderlijk geanalyseerd. Gewogen incrementele opbrengst (IYW) (diagnostische opbrengst van de CE-diagnostische opbrengst van de vergelijkende modaliteit) en 95% betrouwbaarheidsintervallen (CI's) van CE over vergelijkende modaliteiten werden berekend. RESULTATEN: Een totaal van 12 studies (n = 428) ten opzichte van de opbrengst van CE met SBR bij patiënten met een CD. Acht studies (n = 236) ten opzichte van CE met C + IL, vier studies (n = 119) ten opzichte van CE met CTE, twee studies (n = 102) ten opzichte van CE met PE, en vier studies (n = 123) ten opzichte van CE met MRE . Voor de verdachte CD subgroep, verschillende vergelijkingen voldaan statistische significantie. De rendementen in deze subgroep waren CE vs SBR: 52 vs 16% (IYw = 32%, P <0,0001, 95% CI = 16-48%), CE vs CTE: 68 vs 21% (IYw = 47% , P <0,00001, 95% CI = 31-63%), en CE versus C + IL: 47 versus 25% (IYw = 22%, p = 0,009, 95% CI = 5-39%). Statistisch significante opbrengsten voor de CE-versus een alternatieve diagnostische modaliteit in de gevestigde CD patiënten werden gezien bij CE versus PE: 66 versus 9% (IYw = 57%, P <0,00001, 95% CI = 43-71%), CE vs . SBR: 71 tegen 36% (IYw = 38% P <0,00001 95% CI = 22-54%) en vs in CE CTE: 71 vs 39% (IYw = 32%, P = of < 0,0001, 95% CI = 16-47%). CONCLUSIES: Onze meta-analyses blijkt dat CE superieur is aan SBR, CTE,-en C + IL bij de evaluatie van verdachte CD patiënten. CE is ook een meer effectieve diagnostische hulpmiddel in de gevestigde CD-patiënten in vergelijking met SBR, CTE, en PE.
BACKGROUND: Capsule endoscopy (CE) has been widely used in clinical practice. OBJECTIVE: To provide systematically pooled results on the indications and detection, completion, and retention rates of small-bowel CE. DESIGN: A systematic review. MAIN OUTCOME MEASUREMENTS: We searched the PubMed database (2000-2008) for original articles relevant to small-bowel CE for the evaluation of patients with small-bowel signs and symptoms. Data on the total number of capsule procedures, the distribution of different indications for the procedures, the percentages of procedures with positive detection (detection rate), complete examination (completion rate), or capsule retention (retention rate) were extracted and/or calculated, respectively. In addition, the detection, completion, and retention rates were also extracted and/or calculated in relation to indications such as obscure GI bleeding (OGIB), definite or suspected Crohn's disease (CD), and neoplastic lesions. RESULTS: A total of 227 English-language original articles involving 22,840 procedures were included. OGIB was the most common indication (66.0%), followed by the indication of only clinical symptoms reported (10.6%), and definite or suspected CD (10.4%). The pooled detection rates were 59.4%; 60.5%, 55.3%, and 55.9%, respectively, for overall, OGIB, CD, and neoplastic lesions. Angiodysplasia was the most common reason (50.0%) for OGIB. The pooled completion rate was 83.5%, with the rates being 83.6%, 85.4%, and 84.2%, respectively, for the 3 indications. The pooled retention rates were 1.4%, 1.2%, 2.6%, and 2.1%, respectively, for overall and the 3 indications. LIMITATIONS: Inclusion and exclusion criteria were loosely defined. CONCLUSIONS: The pooled detection, completion, and retention rates are acceptable for total procedures. OGIB is the most common indication for small-bowel CE, with a high detection rate and low retention rate. In addition, angiodysplasia is the most common finding in patients with OGIB. A relatively high retention rate is associated with definite or suspected CD and neoplasms.
ACHTERGROND EN DOELSTELLINGEN: Naar de mening van kleine steekproeven van de studies tot nu toe gepubliceerd, de waarde van de video capsule endoscopie (VCE) in de diagnose van coeliakie (CD) moet nog worden bepaald. Het doel van dit werk was het systematisch bepalen van de totale diagnostische kenmerken van de VCE in het diagnosticeren van noncomplicated CD, in vergelijking met de gouden standaard, met behulp van meta-analyse.
PATIËNTEN EN METHODEN: Er is een uitgebreid literatuuronderzoek werd uitgevoerd op zoek naar prospectieve, gecontroleerde studies, met onderzoekers blind voor de resultaten van de pathologie van de kleine darm biopten. Twee onafhankelijke auteurs uitgevoerde data-extractie en de evaluatie van de methodologische kwaliteit van elke proef. Diagnostische kenmerken van elke proef werden verzameld en gebundeld sensitiviteit, specificiteit, likelihood ratio's, en diagnostische odds ratio's werden berekend. Beschrijving van complicaties en kosten opgenomen als gemeld.
Resultaten In totaal zijn er drie studies voldeden aan de inclusiecriteria (n = 107, 63 met CD en 44 zonder). De totale verzamelmonster VCE sensitiviteit was 83% (95% betrouwbaarheidsinterval [BI] = 71-90%) en de specificiteit 98% (95% CI = 88 tot 99,6%). Er werden geen belangrijke complicaties gemeld. De kosten werden alleen genoemd in een onderzoek.
CONCLUSIES: De totale diagnostische kenmerken van VCE, indien gebruikt voor coeliakie, hoewel een goede diagnose te stellen met een ervaren oog, kan geen rechtvaardiging voor het routinematig gebruik van VCE als alternatief voor de pathologie van de kleine darm biopten. Meer studies zijn nodig met de juiste kosten-batenanalyse.
GOALS: To assess the effectiveness, safety, and clinical use of capsule endoscopy (CE) in the diagnosis of small bowel diseases.
STUDY: Systematic review carried out in the main electronic databases, including MEDLINE, EMBASE, and COCHRANE. Papers were selected independently by the 2 researchers and the quality was determined using a purpose-designed scale.
RESULTS: A total of 9 systematic reviews and 28 original papers were included [11 assessed obscure gastrointestinal bleeding, 9 Crohn's disease (CD), and 4 hereditary polyposis syndromes]. The diagnostic yield of CE for the diagnosis of obscure gastrointestinal bleeding ranged from 39% to 77%. The diagnostic yield of push enteroscopy was lower than 40% in all but 1 study. CE detected suggestive findings in 19% to 71% of patients with suspected CD, whereas radiologic techniques did so in only 0% to 37% of the cases. In patients with suspected recurrence, detection with these techniques was 58% to 81% and 19% to 67%, respectively. Endoscopic capsule detected a greater number of polyps in patients with polyposis syndromes but other techniques allowed for better localization.
CONCLUSIONS: Although CE occupies a preferential place in the diagnosis of gastrointestinal bleeding and CD; there is insufficient evidence to establish whether it could be used as a first line diagnostic test. The evidence is insufficient to ascertain this technique's usefulness in small bowel disorders other than obscure bleeding or CD.
BACKGROUND & AIMS: The aim of this study was to compare the diagnostic yield of capsule endoscopy (CE) with double-balloon enteroscopy (DBE) in small-bowel (SB) disease using meta-analysis.
METHODS: We performed a search of studies comparing CE with DBE in SB disease. Data on diagnostic yield of CE and DBE were extracted, pooled, and analyzed. The weighted incremental yield (IY(W)) (yield of CE--yield of DBE) of CE over DBE and 95% confidence intervals (95% CIs) for pooled data were calculated using a fixed-effect model (FEM) for analyses without, and a random-effect model (REM) for analyses with, significant heterogeneity.
RESULTS: Eleven studies compared CE and DBE; the pooled overall yield for CE and DBE was 60% (n = 397) and 57% (n = 360), respectively (IY(W), 3%; 95% CI, -4% to 10%; P = .42; FEM). Ten studies reported vascular findings; the pooled yield for CE and DBE was 24% (n = 371) and 24% (n = 364), respectively (IY(W), 0%; 95% CI, -5% to 6%; P = .88; REM). Nine studies reported inflammatory findings; the pooled yield for CE and DBE was 18% (n = 343) and 16% (n = 336), respectively (IY(W), 0%; 95% CI, -5% to 6%; P = .89; FEM). Nine studies reported polyps/tumors; the pooled yield for CE and DBE was 11% (n = 343) and 11% (n = 336), respectively (IY(W), -1%; 95% CI, -5% to 4%; P = .76; FEM).
CONCLUSIONS: CE and DBE have comparable diagnostic yield in SB disease, including obscure gastrointestinal bleeding. CE should be the initial diagnostic test because of its noninvasive quality, tolerance, ability to view the entire SB, and for determining the initial route of DBE. Because of its therapeutic capabilities, DBE may be indicated in patients with a positive finding on CE requiring a biopsy or therapeutic intervention, if suspicion for a SB lesion is high despite a negative CE, and in patients with active bleeding.
Video capsule endoscopy (VCE) is an attractive and patient friendly tool that provides high quality images of the small bowel. The reported yield of VCE in diagnosing celiac disease (CD) has shown variable results.
OBJECTIVE:
The aim of this study was to assess the accuracy of VCE by pooling data of existing trials.
DESIGN:
Meta-analysis. The fixed-effects or random-effects model was used as appropriate, based on whether homogeneity or heterogeneity, respectively, was indicated by the Cochran Q-test.
PATIENTS:
Studies that estimated the accuracy of VCE were identified. The two investigators independently conducted the search and data extraction. A total of 166 individuals were included in this meta-analysis.
METHODS:
An extensive literature search was performed and studies that estimated the accuracy of VCE in CD were identified. The two investigators independently conducted the search and data extraction. Data from the eligible studies were collected and pooled; sensitivity, specificity, likelihood ratios, and diagnostic odds ratios were computed. In addition, the results of the individual studies were displayed in a receiver operating characteristic (ROC) space to illustrate the distribution of sensitivities and specificities. A weighted symmetric summary ROC curve was computed and the area under the curve (AUC) was calculated, with perfect tests having an AUC of 1 and poor tests having an AUC close to 0.5.
RESULTS:
Out of 461 titles initially generated by the literature searches, six studies met the inclusion criteria and were eligible for meta-analysis. The overall pooled VCE sensitivity was 89% [95% confidence interval (82-94%)] and specificity was 95% [95% confidence interval (89-98%)]. The AUC under the weighted symmetric summary ROC was 0.9584.
CONCLUSION:
The results of this meta-analysis mean that VCE, although it is not as accurate as pathology, could be a reasonable alternative method of diagnosing CD. Hopefully, this method will expand the portfolio of diagnostic methods available, especially in patients unwilling to undergo gastroscopy because of its perceived inconvenience and discomfort. However, larger, multicenter, and well-designed trials are needed to further establish the role of VCE in the diagnosis of CD.
