Video capsule endoscopy vs double-balloon enteroscopy in the diagnosis of small bowel bleeding: A systematic review and meta-analysis

Table 2 Studies characteristics

	Median age; range	Patient total	Study design	VCE Model	DBE Model	Preparation	Interval CE × DBE	No. of patients with diagnoses of SBB by CE/total CE performed	No. of patients with diagnoses of SBB by DBE/total DBE performed
Fujimoto et al[28], 2007	64 (38-93)	45 M: 25 F: 20	Prospective study	Pillcam (Given Imaging, Yoqneam, Israel).	EN-450P5 DBE diagnostic model and/or the EN-450T5	CE: 12 h fast + 1 L sodium sulfate/sodium bicarbonate DBE: 72 h after CE in 36 pct	72 h	18/45 Angiodysplasia: 6 Varices: 2 jejunal	18/36
Hadithi et al[4], 2006	63.2 (19-86)	35 M:22 F: 13	Prospective blinded study	Given M2A, Given Imaging Ltd., Yoqneam, Israel	Fuji Photo Optical Incorporated Company Fujinon Inc., Japan	CE: fast overnight after the ingestion of 1 L of sodium sulfate/sodium bicarbonate solution DBE: fast overnight after ingestion of 1 L clean prep. for the antegrade approach and bowel cleansing as for colonoscopy (4 L Klean prep)	7 to 14 d	21/35 AVM: 19 Fresh blood and clots: 5	28/35 AVM: 16 Fresh blood and clots: 2
Hermans et al[11], 2017	69 (18-91)	146 M: 91 F: 55	Retrospective observational study.	Olympus VC (Olympus EndoCapsule; Tokyo, Japan) and Pillcam VC (Covidien plc, Dublin, Ireland)	Fujinon Double-Balloon Enteroscopy System (Fujinon GMBH, Germany), EN-450T5	CE: 2 L PEG in a single or split dose DBE: 1 L PEG divided into two doses to be used twice	111 (1–1091) days	105/134 Angiodysplasias: 70 active bleedings without visible focus : 35	93/146 Angiodysplasias: 19
Holleran et al[37], 2013	54 (16-90)	246 M: 130 F: 116	Retrospective comparative study	SB1 or SB2 pillcam (Given imaging, Yokneam, Israel)	Fujinon double-balloon enteroscope (EN-450P5/20, Fujinon, Inc., Saitama, Japan)	CE: No preparation was required other than an overnight fast. Anterograde DBE: overnight fast Retrograde DBE: PEG the day prior	NR*	40/46 Angiodysplasia: 10 Active bleeding: 3	116/246 Angiodysplasias: 44
Kaffes et al[34], 2007	62 ± 18	60	Prospective cohort study	M2A; Given Imaging Ltd, Yoqneam, Israel)	Fujinon	CE, DBE: fasting period of 8 h before the oral procedure and a bowel preparation with a sodium (Picoprep; Pharmatel, Thornleigh, Australia)	NR*	45/60 Angiectasia:28 Red spots: 9 Blood: 8	45/60 Angioectasia: 21 Red spots: 9 Blood: 8
Kalra, A et al[16], 2015	66.6 ± 13.2	116 M:65 F: 51	Retrospective review	Medtronic, Duluth, GA, the United States	Fujifilm Medical System, Stanford, CT, the United States	Retrograde DBE: bowel preparation the night before the procedure.	1 yr	/69	29/69 AVM: 29
Kamalaporn et al[30], 2008	64.1 (34-83)	195 M: 26 F:25	Retrospective review	Given M2A CE system (Given Imaging Ltd, Israel)	Fujinon DBE system (Fuji Photo Optical Incorporated Company, Fujinon Inc., Japan)	CE: 2 to 4 L PEG and fasted overnight, at least 8 h before the procedure DBE: 4 L PEG and fasted overnight	139 (40 to 335) d	181/202 studies Angiodysplasia: 33 Bleeding: 22	56/56 Angiodysplasia: 36 Bleeding: 9
Kameda et al[27], 2008	62.4 (27-84)	32 M: 13 F: 19	Prospective single-blind trial	Pill Cam capsule (M2A, Given Imaging, Yoqneam, Israel)	DBE system (FujinonToshiba ES System, Saitama, Japan)	CE: fasting after midnight on the evening before the examination (minimum 8 h) DBE: overnight fasting and ingestion of 1 l of electrolyte lavage preparation (Niflec, Ajinomoto Pharma, Tokyo, Japan) in the morning.	1-7 d	29/32 Angiodysplasia: 8 bleeding: 6	21/32 Angiodysplasia: 7 bleeding: 6
Li et al[35], 2010		190	Prospective study	M2A, Given Imaging, Ltd. (Yoqneam, Israel)	Fujinon EN-450P5/ 20 and EN-450P5/28 (Fujinon Inc., Saitama, Japan)	CE: 1 L of PEG electrolyte 12 h before the procedure Anterograde DBE: fasted for 8 h. Retrograde DBE: PEG electrolytes preparation 4 h before the examination	5.8 d (1-18)	165/190 AVM: 7 Fresh blood or clots: 8	34/51 AVM: 9 Bleeding: 0 Angioma: 4
Lin et al[40], 2007	63.5 ± 22.7 (11-87)	10 M:3 F:7	Prospective study	Pill Cam SB capsule (Given Imaging, Yoqneam, Israel)	DBE: EN- 450P5 and the EN-450T5	CE: fast overnight for 8-12 h Anterograde DBE: fasting for 6-8 h Retrograde DBE: bowel cleansing as in a colonoscopy.	7 d	9/10 Angiodysplasias: 3 Bleeding: 3	8/10 Angiodysplasias: 3 Varices: 1 Dieulafoy’s lesion: 1
Maeda et al[32], 2010	70 (30-92)	89 M: 48 F: 41	Retrospective analysis	PilCam SB® (SB1, SB2, or SB3) (Covidien, Irvine, CA, the United States).	(EN-450 T5/W or EN-580 T, Fujinon Inc., Saitama, Japan)	NR*	24 h	58/89 Angioectasia: 8 AVM : 3 Dieulafoy lesion: 9 Varices: 2	29/37 Angioectasia:8 AVM: 3 Dieulafoy lesion:6 Varice: 1
Marmo R et al[23], 2008	61.6 ± 16.2	193 M: 119 F: 74	Prospective study	Pillcam SB	Fujinon Double-Balloon Enteroscopy System	Anterograde DBE: fasting period of 8 h Retrograde DBE: 4 L PEG-based preparation	2 wk	175/193 Vascular lesions: 74 Blood or clot: 34	132/193 Vascular lesions: 72
Tian Min et al[39], 2013	55.4 (23-78)	62 M: 34 F:28	Prospective study	Pill Cam SB capsule	EN-450P5 and the EN-450T5 (Fujinon)	CE: 2 L to 4 L PEG and fasted overnight Anterograde DBE: fasting for 6-8 h before the procedure. Retrograde DBE: bowel cleansing as in a colonoscopy.	15 (4-60) d	44/62 Angiodysplasia: 26 Bleeding: 26	48/62 Angiodysplasia: 27 Bleeding: 30
Nakamura et al[29], 2006	58.5 (25 ± 85)	32 M: 21 F: 11	Prospective and blinded	M2A, Given Imaging,	Fuji EN−450 T5/20	CE: fluid diet for 12 h and observed a fasting period starting at midnight Anterograde DBE: fasted for 12 h Retrograde DBE: clear liquid diet on the day before the examination and PEG electrolyte lavage solution on the morning of the examination	48 h	19/32 Angiodysplasias: 4 Red spots: 2	12/28 Angiodysplasias: 2 Red spots: 2
Rahmi et al[33], 2013	67 ± 11	383 M: 114 F: 269	Prospective, multicenter study	PillCam SB device	EN-450P5 and EN-450T5; Fujinon	CE: residue-free diet 2 d before VCE ingestion; 2 L PEG solution the night before the examination; patients then fasted overnight Anterograde DBE: No bowel preparation Retrograde DBE: 4 L of a PEG solution was given the day before the procedure	4.1 ± 6.3 mo	266/383 Angiodysplasia: 266	205/266 Angiodysplasia: 190
Chu et al[17], 2016	51.1 ± 17.1	121 M: 60 F: 61	Study Cohorts	OMOM capsule endoscopic device (Jinshan Science and Technology Group Co., Ltd, Chongqing, China)	Fujinon EN-450P5/20	CE: 2 L polyethylene glycol-based electrolyte solution 12 h prior to the test, followed by an overnight fast for bowel preparation fast Retrograde DBE: bowel preparation used for CE procedure the day before the examination	1 wk	115/121 Angiodysplasia: 86% Active bleeding: 6	29/46 Angiodysplasia: 9
Zhang et al[15], 2015	47.19 (16-78)	88 M: 64 F: 24	Prospective study	Pill Cam SB	Fuji DBE system	CE: 3 liters of PEG (2 liters at 10:00 pm the night before the procedure, and 1 L with the simethicone at 4:00 am on the morning of the procedure) Anterograde DBE: fast for 6-8 h Retrograde DBE: 2 L of PEG	NR	53/88 MAV: 14 Hemangioma: 0 Diverticulum with a Bleeding: 1	52/88 MAV: 10 Hemangioma: 3 Diverticulum with a Bleeding: 7

M: Male; F: Female; SBB: Small bowel bleeding; PEG: Polyethylene glycol solution; AVM: Arteriovenous malformation; VC: Video capsule; NR: Not related; DBE: Double-balloon enteroscopy; VCE: Video capsule endoscope.