DBE Insertion Route in Small Bowel Lesions Detected by Capsule Endoscopy: Which Way to go?

Aims When capsule endoscopy (CE) examination reveals a small bowel (SB) lesion, selection of the insertion route for double-balloon enteroscopy (DBE) is pivotal. Few progression- and time-based indices/indicators have been proposed for this clinical challenge. In this study, we systematically reviewed the reported success and outcomes of these indicators in determining the DBE route of insertion.

Methods An extensive literature search was performed. Papers assessing the role of CE on DBE’s route of insertion selection were screened. The success rate of DBE in reaching an SB target lesion (highlighted by CE) was the primary outcome, measured as the rate positive initial DBE to the total number of procedures. STROBE and PRISMA statements were used to determine the risk of bias and data reporting, respectively. Meta-analysis was not possible as time measurements of single CE procedures were not available.

Results Seven studies were selected, including 262 CE which required DBE procedures. Time-based indices were used in six studies, whereas the PillCam™ Progress indicator was used in one study ([Fig. 1]). DBE insertion route was selected according to each indicator’s specific cut-off, as SB lesions were localized using established anatomical landmarks; in one study, the mouth-cecum transit time was used. The success rate of initial DBE was high in all included studies, ranging from 78.3 % to 100 %.

Fig.1

Conclusions Choosing the appropriate DBE’s insertion route remains an open issue. Several groups attempted to provide tools that may predict the precise localization of SB lesions, but larger studies are required to determine the most efficient indicator. Notwithstanding, although current evidence does not allow any strong recommendation, the success rate of available CE transit-related indices is high, thereby allowing clinicians to safely use the tool they feel more confident with.

Citation: Cortegoso Valdivia P, Skonieczna-Żydecka K, Pennazio M et al. eP94 DBE INSERTION ROUTE IN SMALL BOWEL LESIONS DETECTED BY CAPSULE ENDOSCOPY: WHICH WAY TO GO? Endoscopy 2021; 53: S127.

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Artikel online veröffentlicht:
19. März 2021