Combined Use of Capsule Endoscopy and Double-Balloon Enteroscopy in the Diagnosis of Obscure Gastrointestinal Bleeding: Meta-Analysis and Pooled Analysis

Background/Aims: Capsule endoscopy (CE) and double-balloon endoscopy (DBE) have their respective advantages and disadvantages of diagnosis of obscure gastrointestinal bleeding (OGIB). Our aim was to evaluate the diagnostic yield and outcome of CE combined with DBE in patients with OGIB. Methodology: By searching PubMed, two reviewers identified prospective or retrospective studies comparing CE with DBE in the diagnosis of OGIB. A meta- and pooled-analysis was performed. Results: In 712 patients with OGIB recruited in the 12 eligible studies, the overall diagnostic yield of CE compared with DBE was similar. In sub-analyses, the diagnostic yields between CE and DBE for vascular lesions, ulcerative/inflammatory lesions and tumors/neoplasia were also similar, but for fresh blood/clots (CE 21.8% vs. DBE 3.3%, p<0.00001) and diverticalum (CE 0.6% vs. DBE 3.97%, p = 0.02) did differ significantly. Of 205 patients with ()GIB, 148 (72.2%) were detected by CE but not by DBE and 57 (27.8%) were detected by DBE but not by CE. In 52 patients with fresh blood/clots detected by CE, DBE found fresh blood/dots only in one (1.9%) of the 52 patients and made a new or clarified diagnosis in 51 (98.1%). Conclusions: Each approach detected some lesions not seen by the other. Combined use of CE and DBE in diagnosis of OGIB is better than either modality alone.