ABSTRACT
INTRODUCCIÓN Y OBJETIVO: la capsula endoscópica y la enteroscopia de doble balón son técnicas de reconocido valor en el estudio de la hemorragia digestiva media, habiendo numerosos factores que pueden afectar a su rendimiento diagnóstico. El objetivo del presente estudio es el de caracterizar y definir los niveles de concordancia entre ambas focalizando en el tipo de lesión, en una gran cohorte de pacientes de un centro de referencia. MATERIAL Y MÉTODO: entre los años 2004-2014 se administraron 1.209 cápsulas en 1.078 pacientes y se realizaron 381 enteroscopias en 361 pacientes con hemorragia digestiva media. RESULTADOS: en 332 pacientes (edad media: 65,22 ± 15,41, 183 hombres) se realizaron ambos procedimientos. Ambas técnicas tuvieron un rendimiento diagnóstico similar (70,5% vs. 69,6%, p = 0,9). El rendimiento diagnóstico global de la enteroscopia fue superior en pacientes con una cápsula previa positiva (79,3% vs. 27,9%, p < 0,001). La concordancia diagnóstica entre los resultados por cápsula y enteroscopia para cada lesión fue muy buena para pólipos (0,89 [95% IC: 0,78-0,99]), buena en las lesiones vasculares (0,66 [95% IC: 0,55-0,77]), tumores (0,66 [95% IC: 0,55-0,76]) y moderada para úlceras (0.56 [95% IC: 0,46-0,67]). Los divertículos (0,39 [95% IC: 0,29-0,5] tuvieron una concordancia razonable. Los resultados entre ambos procedimientos difirieron en 73 pacientes (22%). CONCLUSIONES: el presente estudio evidencia que aunque el rendimiento de la cápsula endoscópica y la enteroscopia de doble balón de forma global sean similares, hay numerosos factores que pueden modificar estos valores, siendo el principal el tipo de lesión
BACKGROUND AND AIM: Capsule endoscopy and doubleballoon enteroscopy are well-recognized procedures in obscure gastrointestinal bleeding, with many factors that may influence their diagnosis yield. The aim of the present study was to characterize the degree of agreement between both techniques with focus on the type of lesion in a large cohort of patients at a referral center. MATERIAL AND METHOD: One thousand two hundred and nine capsules were administered in 1,078 patients and 381 enteroscopies were performed in 361 patients with obscure-gastrointestinal bleeding from 2004 to 2014. RESULTS: Both procedures were carried out in 332 patients (mean age: 65.22 ± 15.41, 183 men) and they have a similar diagnosis yield (70.5% vs. 69.6%, p = 0.9). Overall enteroscopy diagnosis yield was higher within patients with a previous positive capsule endoscopy (79.3% vs. 27.9%, p < 0.001). The degree of agreement was very good for polyps (0.89 [95% CI: 0.78-0.99]), good for vascular lesions (0.66 [95% CI: 0.55-0.77]) and tumors (0.66 [95% CI: 0.55-0.76]) and moderate for ulcers (0.56 [95% CI: 0.46-0.67]). Diverticula (0.39 [95% CI: 0.29-0.5]) achieved a fair agreement. The results of CE and DBE differed in 73 patients (22%). CONCLUSIONS: The present study confirms that although overall diagnostic yield by capsule endoscopy and double-balloon enteroscopy is similar, there are many factors which can modify these values, mainly the type of lesion
Subject(s)
Female , Humans , Male , Double-Balloon Enteroscopy/instrumentation , Gastrointestinal Hemorrhage/blood , Capsule Endoscopes/standards , Crohn Disease/metabolism , Crohn Disease/pathology , Ulcer/complications , Ulcer/mortality , Pylorus/abnormalities , Pylorus/injuries , Anesthesia/methods , Double-Balloon Enteroscopy/methods , Gastrointestinal Hemorrhage/genetics , Capsule Endoscopes , Crohn Disease/complications , Crohn Disease/diagnosis , Ulcer/genetics , Ulcer/pathology , Pylorus/cytology , Pylorus/pathology , AnesthesiaABSTRACT
BACKGROUND AND AIM: Capsule endoscopy and double balloon enteroscopy are well-recognized procedures in obscure gastrointestinal bleeding, with many factors that may influence their diagnosis yield. The aim of the present study was to characterize the degree of agreement between both techniques with focus on the type of lesion in a large cohort of patients at a referral center. MATERIAL AND METHOD: One thousand two hundred and nine capsules were administered in 1,078 patients and 381 enteroscopies were performed in 361 patients with obscure-gastrointestinal bleeding from 2004 to 2014. RESULTS: Both procedures were carried out in 332 patients (mean age: 65.22 +/- 15.41, 183 men) and they have a similar diagnosis yield (70.5% vs. 69.6%, p = 0.9). Overall enteroscopy diagnosis yield was higher within patients with a previous positive capsule endoscopy (79.3% vs. 27.9%, p < 0.001). The degree of agreement was very good for polyps (0.89 [95% CI: 0.78-0.99]), good for vascular lesions (0.66 [95% CI: 0.55-0.77]) and tumors(0.66 [95% CI: 0.55-0.76]) and moderate for ulcers (0.56 [95% CI: 0.46-0.67]). Diverticula (0.39 [95% CI: 0.29-0.5]) achieved a fair agreement. The results of CE and DBE differed in 73 patients (22%). CONCLUSIONS: The present study confirms that although overall diagnostic yield by capsule endoscopy and double-balloon enteroscopy is similar, there are many factors which can modify these values, mainly the type of lesion.
