Capsule endoscopy transit-related indicators in choosing the insertion route for double-balloon enteroscopy: a systematic review

Abstract

Background and study aims When capsule endoscopy (CE) detects a small bowel (SB) target lesion that may be manageable with enteroscopy, the selection of the insertion route is critical. Time- and progression-based CE indices have been proposed for localization of SB lesions. This systematic review analysed the role of CE transit indicators in choosing the insertion route for double-balloon enteroscopy (DBE).

Methods A comprehensive literature search identified papers assessing the role of CE on the choice of the route selection for DBE. Data on CE, criteria for route selection, and DBE success parameters were retrieved and analyzed according to the PRISMA statement. Risk of bias was assessed through the STROBE assessment. The primary outcome evaluated was DBE success rate in reaching a SB lesion, measured as the ratio of positive initial DBE to the number of total DBE.

Results Seven studies including 262 CEs requiring subsequent DBE were selected. Six studies used time-based indices and one used the PillCam Progress indicator. SB lesions were identified and insertion route was selected according to a specific cut-off, using fixed landmarks for defining SB transit except for one study in which the mouth-cecum transit was considered. DBE success rate was high in all studies, ranging from 78.3 % to 100 %. Six of seven studies were high quality.

Conclusions The precise localization of SB lesions remains an open issue, and larger studies are required to determine the most accurate index for selecting the DBE insertion route. In the future, 3 D localization technologies and tracking systems will be essential to accomplish this tricky task.

• References

• 1 Pennazio M, Venezia L, Cortegoso Valdivia P. et al. Device-assisted enteroscopy: An update on techniques, clinical indications and safety. Dig Liver Dis 2019; 51: 934-943
• 2 Rondonotti E, Spada C, Adler S. et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review. Endoscopy 2018; 50: 423-446
• 3 Pennazio M, Spada C, Eliakim R. et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2015; 47: 352-386
• 4 Pérez-Cuadrado Robles E, Pinho R, González-Suárez B. et al. Small bowel enteroscopy - A joint clinical guideline by the Spanish and Portuguese small-bowel study groups. Rev Esp Enferm Dig 2020; 112: 309-318
• 5 Liberati A, Altman DG, Tetzlaff J. et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 2009; 62: e1-34
• 6 Vandenbroucke JP, von Elm E, Altman DG. et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Int J Surg 2014; 12: 1500-1524
• 7 Gay G, Delvaux M, Fassler I. Outcome of capsule endoscopy in determining indication and route for push-and-pull enteroscopy. Endoscopy 2006; 38: 49-58
• 8 Lin T-N, Su M-Y, Hsu C-M. et al. Combined use of capsule endoscopy and double-balloon enteroscopy in patients with obscure gastrointestinal bleeding. Chang Gung Med J 2008; 31: 450-456
• 9 Li X, Chen H, Dai J. et al. Predictive role of capsule endoscopy on the insertion route of double-balloon enteroscopy. Endoscopy 2009; 41: 762-766
• 10 Nakamura M, Ohmiya N, Shirai O. et al. Route selection for double-balloon endoscopy, based on capsule transit time, in obscure gastrointestinal bleeding. J Gastroenterol 2010; 45: 592-599
• 11 Chalazan B, Gostout CJ, Song LM. et al. Use of capsule small bowel transit time to determine the optimal enteroscopy approach. Gastroenterology Res 2012; 5: 39-44
• 12 Maeda Y, Moribata K, Deguchi H. et al. Video capsule endoscopy as the initial examination for overt obscure gastrointestinal bleeding can efficiently identify patients who require double-balloon enteroscopy. BMC Gastroenterol 2015; 15: 132
• 13 Tsuboi A, Oka S, Tanaka S. et al. The clinical usefulness of the PillCam progress indicator for route selection in double balloon endoscopy. Intern Med 2019; 58: 1375-1381
• 14 Khashab MA, Pasha SF, Muthusamy VR. et al. The role of deep enteroscopy in the management of small-bowel disorders. Gastrointest Endosc 2015; 82: 600-607
• 15 Yamamoto H, Ogata H, Matsumoto T. et al. Clinical Practice Guideline for Enteroscopy. Dig Endosc 2017; 29: 519-546
• 16 Koulaouzidis A, Marlicz W, Wenzek H. et al. Returning to digestive endoscopy normality will be slow and must include novelty and telemedicine. Dig Liver Dis 2020;
• 17 Koulaouzidis G, Charisopoulou D, Wojakowski W. et al. Telemedicine in cardiology in the time of coronavirus disease 2019: a friend that everybody needs. Pol Arch Intern Med 2020; 130: 559-561
• 18 Vasilakakis M, Koulaouzidis A, Yung DE. et al. Follow-up on: optimizing lesion detection in small bowel capsule endoscopy and beyond: from present problems to future solutions. Expert Rev Gastroenterol Hepatol 2019; 13: 129-141
• 19 Steiger C, Abramson A, Nadeau P. et al. Ingestible electronics for diagnostics and therapy. Nat Rev Mater 2019; 4: 83-98
• 20 Eliakim R, Spada C, Lapidus A. et al. Evaluation of a new pan-enteric video capsule endoscopy system in patients with suspected or established inflammatory bowel disease - feasibility study. Endosc Int Open 2018; 06: E1235-E1246
• 21 Marya NB, Jawaid S, Foley A. et al. A randomized controlled trial comparing efficacy of early video capsule endoscopy with standard of care in the approach to nonhematemesis GI bleeding (with videos). Gastrointest Endosc 2019; 89: 33-43.e4
• 22 Iakovidis DK, Koulaouzidis A. Software for enhanced video capsule endoscopy: challenges for essential progress. Nat Rev Gastroenterol Hepatol 2015; 12: 172-186
• 23 Ciuti G, Caliò R, Camboni D. et al. Frontiers of robotic endoscopic capsules: a review. J Micro-Bio Robot 2016; 11: 1-18
• 24 Karargyris A, Koulaouzidis A. OdoCapsule: next-generation wireless capsule endoscopy with accurate lesion localization and video stabilization capabilities. IEEE Trans Biomed Eng 2015; 62: 352-360
• 25 Wadhwa V, Sethi S, Tewani S. et al. A meta-analysis on efficacy and safety: single-balloon vs. double-balloon enteroscopy. Gastroenterol Rep (Oxf) 2015; 3: 148-155
• 26 Baniya R, Upadhaya S, Subedi SC. et al. Balloon enteroscopy versus spiral enteroscopy for small-bowel disorders: a systematic review and meta-analysis. Gastrointest Endosc 2017; 86: 997-1005
• 27 Mandaliya R, Korenblit J, O’Hare B. et al. Spiral enteroscopy utilizing capsule location index for achieving high diagnostic and therapeutic yield. Diagn Ther Endosc 2015; 2015: 1-7
• 28 Sanaka M, Navaneethan U, Kosuru B. et al. Antegrade is more effective than retrograde enteroscopy for evaluation and management of suspected small bowel disease. Clin Gastroenterol Hepatol 2012; 10: 910-916
• 29 Davie M, Yung DE, Douglas S. et al. Mapping the distribution of small bowel angioectasias. Scand J Gastroenterol 2019; 54: 597-602