Diagnostic yield of video capsule endoscopy vs simple balloon enteroscopy in small intestinal disorders: A systematic review

Table 1 Study characteristics

Ref.	Design	Total (n)	Included (n)	Age	Modalities	Small bowel disorders identified			Findings
							VCE	SBE
Shiani et al[13]	Retrospective	418	95 with OBGIB	65.8 ± 12.2	VCE and SBE	Vascular lesions	39	30	CE remains the preferred initial test for evaluating stable patients with OGIB, given its good concordance with key small bowel findings. However, in cases of severe overt small bowel bleeding, BAE may be a better first choice, as it allows for both diagnosis and immediate therapeutic intervention, avoiding delays in treatment. Future research should improve CE interpretation and enhance BAE's ability to comprehensively evaluate the entire small bowel for more effective management of OGIB cases
						Active blood clots	34	25
						Ulcer	15	9
						Tumor/mass	2	1
						Polyp	6	7
Ma et al[1]	Retrospective	700	700 suspected small bowel diseases	45.3 ± 15.1	VCE and SBE	Diagnostic yield			No complications from the two procedures
						VCE	SBE	VCE before SBE
						57.60%	69.70%	93.30%
						Comparisons in findings
						Overall detection rate	57.60%	69.70%
						Superficial ulcers and erosions	42.40%	45.10%
						Crohn's disease	11.30%	35.00%
						Bleeding	2.20%	0%
						Parasites	5.60%	0.40%
Vere et al[14]	Retrospective	29	21 patients	NR	VCE and SBE	Combined diagnosis of VCE and SBE			Combining VCE and SBE offers significant advancements in exploring the small bowel. However, histological examination remains the most definitive method for determining the exact nature of lesions
						Inflammatory lesions	23.80%
						Tumoral lesions	52.38%
Trifan et al[15]	Retrospective	3	3	52 ± 11	VCE and SBE	Adenocarcinomas	33.30%		SBE is a safe and effective procedure that overcomes many limitations of VCE, especially regarding therapeutic intervention and histopathological confirmation. Both procedures are complementary in diagnosing suspected SBTs. VCE is recommended as the initial diagnostic tool due to its non-invasive nature, offering broad visualization of the small bowel. If abnormalities are detected, SBE should follow to confirm the diagnosis through histopathology and perform endoscopic therapy if necessary. This sequential approach optimizes both diagnostic accuracy and therapeutic outcomes
						Stromal tumors	66.70%
Cañadas Garrido et al[16]	Retrospective	428	74 VCEs, 71 enteroscopy1	63.9 ± 13.5	VCE and SBE/DBE	Diagnostic yield			Both VCE and enteroscopy had a comparable overall detection rate for small bowel lesions. However, the type of lesion significantly influenced diagnostic agreement. Although the agreement was stronger for inflammatory lesions, it was moderate for conditions like angiectasias and tumors. The results between the two methods differed in 38 patients (51.3%). Additionally, there was one case of complete capsule retention (1.4%), and active bleeding was identified in 13 patients (17.6%). This suggests that while both techniques are effective, the lesion type plays a critical role in shaping diagnostic outcomes
						VCE	SBE1
						86.50%	58.10%
Ooka et al[17]	Retrospective	194	103 VCE and 91 SBE	67 ± 17	VCE and SBE	Small bowel disorders identified			Both CE and SBE are valuable diagnostic tools for OGIB. However, for cases of overt or ongoing bleeding, SBE may be more suitable. This is because SBE allows for a precise endoscopic diagnosis and immediate therapeutic intervention, such as coagulation of bleeding lesions, during the same procedure. In contrast, while CE is effective for initial diagnosis and non-invasive exploration, it cannot provide real-time treatment, which can be crucial in active bleeding scenarios. Thus, SBE offers an advantage when simultaneous diagnosis and therapy are needed
							VCE	SBE
						Vascular lesions	34	34
						Ulcer	10	28
						Tumor/mass	3	2
						Diverticulum	2	3

¹Undefined, both single-balloon and double-balloon enteroscopic interventions.

VCE: Video capsule endoscopy; SBE: Single balloon enteroscopy; OBGIB: Obscure gastrointestinal bleeding; CE: Capsule endoscopy; BAE: Balloon-assisted enteroscopy; SBT: Small bowel tumors.

Table 2 Quality Assessment of Diagnostic Accuracy Studies tool for assessing the quality of the included studies

Ref.	Consecutive/random sample	Case-control design	Avoided inappropriate exclusions	Avoided patient selection bias	Index test interpretation bias	Reference standard classification	Patient flow bias
Shiani et al[13]	Yes	Yes	Low	Low	Yes	Low	Yes
Ma et al[1]	Unclear	Yes	Moderate	Low	No	Low	Yes
Vere et al[14]	Unclear	No	High	Low	Yes	Low	No
Trifan et al[15]	Yes	Yes	Low	Low	Yes	Low	Yes
Cañadas Garrido et al[16]	Yes	Yes	Low	Low	Yes	Low	Yes
Ooka et al[17]	Yes	Yes	Low	Low	Yes	Low	Yes