Degree of concordance between single balloon enteroscopy and capsule endoscopy for obscure gastrointestinal bleeding after an initial positive capsule endoscopy finding
| Autor: | Brijesh Patel, Patrick G. Brady, Seth Lipka, Ashok Shiani, Javier Nieves, Ambuj Kumar |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
medicine.medical_specialty
education.field_of_study Retrospective review business.industry Concordance Population Gastroenterology Mean age Single-Balloon Enteroscopy law.invention Surgery 03 medical and health sciences 0302 clinical medicine Capsule endoscopy law medicine lcsh:Diseases of the digestive system. Gastroenterology 030211 gastroenterology & hepatology In patient 030212 general & internal medicine lcsh:RC799-869 education business Original Research Obscure gastrointestinal bleeding |
| Zdroj: | Therapeutic Advances in Gastroenterology, Vol 9 (2016) |
| ISSN: | 1756-2848 |
| Popis: | Introduction: In patients with obscure gastrointestinal bleeding (OBGIB) capsule endoscopy (CE) is the initial diagnostic procedure of choice. Often patients undergo single balloon enteroscopy (SBE) with both diagnostic and therapeutic intention after CE. Although SBE offers a therapeutic benefit, long procedure times, complexity, and invasiveness are drawbacks. We aimed to evaluate the diagnostic correlation between these two modalities after an initial positive CE finding. Methods: We performed a retrospective review of 418 patients who underwent CE at our institution from January 2010 to May 2014. A total of 95 patients were analyzed after selecting patients that underwent SBE originally after a positive CE result for the evaluation for OGIB. Agreement beyond chance was evaluated using the κ coefficient. A p value less than 5% was considered statistically significant. Results: The mean age of our population was 65.8 ± 12.2 and it was female predominant: 57/95 (60%). The most frequent positive findings were vascular lesions found on SBE in 31.6% and on CE in 41.1%. There was a strong agreement when identifying active bleeding and clots [κ=0.97; 95% confidence interval (CI) 0.92–1.03; p ⩽ 0.0001], and a moderate agreement when diagnosing vascular lesions (0.41; 95% CI 0.21–0.61; p ⩽ 0.0001). There was fair agreement for ulcers (0.26; 95% CI 0.07–0.59; p = 0.005). There was a low correlation between masses, polyps, and others. Conclusion: CE still remains the initial test of choice in evaluating stable patients with OBGIB since it has strong-to-fair concordance for the major small bowel findings. However, in cases of severe overt small bowel bleeding, balloon-assisted enteroscopy can be considered the initial procedure of choice since it is therapeutic as well as diagnostic and this approach avoids delays in treatment. Further research should focus on methods to improve interpretation of CE and enhance the ability to evaluate the entire small bowel with SBE. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|