Capsule endoscopy and single-balloon enteroscopy in small bowel diseases: Competing or complementary?

AIM: To evaluate diagnostic yields of capsule endoscopy (CE) and/or single-balloon enteroscopy (SBE) in patients with suspected small bowel diseases. METHODS: We retrospectively analyzed 700 patients with suspected small bowel diseases from September 2010 to March 2016. CE, SBE, or SBE with prior CE was performed in 401, 353, and 47 patients, respectively. Data from clinical and endoscopy records were collected for analysis. Indications, procedure times, diagnostic yields, and complications were summarized and evaluated. RESULTS: The overall diagnostic yield for the CE group was 57.6%. The diagnostic yield of CE in patients with obscure gastrointestinal bleeding (OGIB) was significantly greater than that in patients with no bleeding (70.5% vs 43.8%, P < 0.01). The overall diagnostic yield of SBE was 69.7%. There was no difference in the diagnostic yield of SBE between patients with OGIB and those with no bleeding (72.5% vs 68.9%, P = 0.534). Forty-seven patients underwent CE prior to SBE. Among them, the diagnostic yield of SBE with positive findings on prior CE was 93.3%. In addition, SBE detected two cases with superficial ulcer and erosive lesions in the small bowel, which were missed by CE. However, one case with lymphoma and two with Crohn's disease were not confirmed by SBE. The rate of capsule retention was 2.0%. There were no significant complications during or after SBE examinations. CONCLUSION: SBE is a safe and effective technique for diagnosing small bowel diseases. SBE with prior CE seemed to improve the diagnostic yield of small bowel diseases.

Use of antibiotics in patients with Crohn's disease: a systematic review and meta-analysis.

OBJECTIVES: Some studies have suggested that antibiotic treatment might be efficient for patients with active Crohn's disease (CD). However, the results are conflicting. The aim of this study was to summarize the available evidence on the efficacy of antibiotics, especially ciprofloxacin, in treating patients with CD. METHODS: A literature search was conducted on the PubMed, Medline, Web of Science and Excerpta Medica Database (EMBASE) for manuscripts published until March 2014. Randomized controlled trials that mainly evaluated the efficacy of antibiotic treatment in patients with CD using clinical remission or response as the key outcome of interest were included. Intention-to-treat analyses were used to evaluate the relative risk (RR) and 95% confidence intervals (CI). RESULTS: In all, 15 randomized placebo-controlled clinical trials involving 1407 participants were included in the meta-analysis. A pooled analysis revealed that compared with placebo, antibiotics benefited CD patients to a certain extent (RR 1.33, 95% CI 1.17-1.51, P < 0.00001). The random-effects model showed that there was no significant difference between patients treated with ciprofloxacin and placebo (combined RR 1.35, 95% CI 0.92-1.97, P = 0.12). However, ciprofloxacin exhibited significant clinical benefits in patients with perianal fistulas (RR 1.64, 95% CI 1.16-2.32, P = 0.005). CONCLUSIONS: The utility of antibiotics was beneficial for patients with CD. Nevertheless, subgroup analyses indicated that treatment with ciprofloxacin alone was significantly efficient for CD patients with perianal fistulas.

Biologics for the prevention of postoperative Crohn's disease recurrence: A systematic review and meta-analysis.

AIM: To evaluate the efficacy and safety of biologics in the prevention of postoperative recurrence of Crohn's disease. METHODS: Published papers and conference literatures were screened for suitable studies. The main outcome measures were clinical, endoscopic recurrence and adverse events. RESULTS: Seven controlled trials met the inclusion criteria for this meta-analysis. At one year postoperation, the biologic therapies showed significant preventative effects in clinical recurrence (RR=0.36, 95% CI: 0.16-0.79; P=0.01), endoscopic recurrence (RR=0.16, 95% CI: 0.07-0.34; P<0.01) and severe endoscopic recurrence (RR=0.17, 95% CI: 0.04-0.71; P=0.02) when compared with the control arms. Similarly, two years postresection, the use of biologics significantly reduced the risk of clinical, endoscopic and severe endoscopic recurrence relative to the controls. Although the biologic agents were not more effective than azathioprine in preventing clinical recurrence (P=0.14), they were more effective in preventing endoscopic recurrence (RR=0.09, 95% CI: 0.02-0.47; P<0.01). Moreover, administration of the biologics was not associated with any significant difference in the rate of adverse events (RR=1, 95% CI: 0.75-1.34; P=0.99) or severe adverse events (RR=1.03, 95% CI: 0.33-3.26; P=0.96) when compared with controls. CONCLUSION: Biologics are superior to azathioprine and traditional therapies and are not associated with increased adverse events in the postoperative treatment of Crohn's disease.