Randomized controlled trial comparing outcomes of video capsule endoscopy with push enteroscopy in XXXX .

@entity1 @entity360 @entity548
BACKGROUND: Optimal management of @entity360 ( @entity360 ) remains unclear. OBJECTIVE: To evaluate diagnostic yields and downstream clinical outcomes comparing video capsule endoscopy (VCE) with push enteroscopy (PE). METHODS: @entity1 with @entity360 and negative esophagogastroduodenoscopies and colonoscopies were randomly assigned to VCE or PE and followed for 12 months. End points included diagnostic yield, @entity548 , health resource utilization and crossovers. RESULTS: Data from 79 @entity1 were analyzed (VCE n=40; PE n=39; 82.3% overt @entity360 ). VCE had greater diagnostic yield (72.5% versus 48.7%; P<0.05), especially in the distal small bowel (58% versus 13%; P<0.01). More VCE-identified lesions were rated possible or certain causes of @entity548 (79.3% versus 35.0%; P<0.05). During follow-up, there were no differences in the rates of ongoing @entity548 (acute [40.0% versus 38.5%; P not significant], chronic [32.5% versus 45.6%; P not significant]), nor in health resource utilization. Fewer VCE-first @entity1 crossed over due to ongoing @entity548 (22.5% versus 48.7%; P<0.05). CONCLUSIONS: A VCE-first approach had a significant diagnostic advantage over PE-first in @entity1 with @entity360 , especially with regard to detecting small bowel lesions, affecting clinical certainty and subsequent further small bowel investigations, with no subsequent differences in @entity548 or resource utilization outcomes in follow-up. These findings question the clinical relevance of many of the discovered endoscopic lesions or the ability to treat most of these effectively over time. Improved prognostication of both @entity1 characteristics and endoscopic lesion appearance with regard to @entity548 behaviour, coupled with the impact of therapeutic deep enteroscopy, is now required using adapted, high-quality study methodologies.
