A Prospective Study on Evaluating the Diagnostic Yield of Video Capsule Endoscopy Followed by Directed Double-Balloon Enteroscopy in Patients with Obscure Gastrointestinal Bleeding

Video capsule endoscopy (VCE) and double-balloon enteroscopy (DBE) are two novel methods for examining the small bowel and could be complementary to each other. The aim of the present study is to prospectively evaluate the diagnostic yield of VCE followed by a directed DBE in patients with obscure gastrointestinal (GI) bleeding. Patients with obscure gastrointestinal bleeding for a complete VCE examination were involved in the study. DBE was recommended after a negative or indeterminate finding of VCE. The diagnostic and follow-up data were collected for analysis. A total of 190 patients with a complete VCE examination were enrolled in the study. The overall positive detection rate for small-bowel disease in the VCE group was 86.8% (165/190), while 63.7% (121/190) patients were definitely diagnosed. Fifty-one patients with indeterminate (44 cases) and negative (seven cases) findings of first VCE underwent DBE procedures. A total of 18 patients with negative VCE findings refused the further examination. DBE demonstrated a positive finding in 66.7% (34/51) patients, 33 from indeterminate group and one from the negative group. Following an unrevealing DBE, at surgical follow-up, three further negative DBE procedures were documented. The overall diagnostic yield was 88.9%, including 121 diagnoses made by VCE alone and 48 by both VCE and DBE (confirmed at surgery or other treatments). The negative predictive value (NPV) and positive predictive value (PPV) of DBE in indeterminate VCE were 81.8 and 100%, respectively. Capsule endoscopy followed by directed double-balloon enteroscopy is a good strategy for investigating the causes of obscure GI bleeding and especially in confirming indeterminate and negative findings from VCE.