EARLY CAPSULE ENDOSCOPY AND DEVICE-ASSISTED ENTEROSCOPY IN OVERT BLEEDING: A SYSTEMATIC REVIEW WITH META-ANALYSIS

Aims The best timing for small bowel capsule endoscopy (SBCE) and device-assisted enteroscopy (DAE) for the management of obscure gastrointestinal bleeding (OGIB) remains unknown. This meta-analysis aimed to compare, for the first time, diagnostic and therapeutic yields, detection of active bleeding and vascular lesions, rebleeding, and mortality of “early” versus “non-early” SBCE and DAE.

Methods Three online databases were searched to identify studies comparing “early” versus “non-early” SBCE and DAE. Random effects meta-analysis was performed; reporting quality was also assessed.

Results From 1974 records, 39 were included (4825 patients). Time intervals for the “early” approach varied, until 14 days in SBCE and 72h in DAE. The pooled diagnostic and therapeutic yields of “early” DAE were superior to those of SBCE (7.97% and 20.89%, respectively, p<0.05). The odds for active bleeding (odds ratio [OR] 5.09, I2=53%), positive diagnosis (OR 3.99, I2=45%), and therapeutic intervention (OR 3.86, I2=67%) were higher in the “early” group for SBCE and DAE (p<0.01). Regarding diagnostic yield, subgroup effects existed for the number of patients in the “early” approach. Our study failed to identify differences when studies were classified according to time intervals for early DAE (I2<5%), yet the analysis was limited due to a lack of data availability. Lower rebleeding in “early” SBCE and DAE was observed (OR 0.40, p<0.01, I2=0%).

Conclusions The role of small bowel studies in the early evaluation of OGIB is unquestionable, impacting diagnosis, therapeutic, and prognosis. Comparative studies are still needed to identify the best timings.

Publication History

Article published online:
14 April 2022