Capsule Endoscopy in the Assessment of Obscure XXXX : An Evidence-Based Analysis.

@entity1 @entity158 @entity360 @entity548
BACKGROUND: Obscure @entity360 (OGIB) is defined as persistent or recurrent @entity548 associated with negative findings on upper and lower gastrointestinal (GI) endoscopic evaluations. The diagnosis and management of @entity1 with OGIB is particularly challenging because of the length and complex loops of the small intestine. Capsule endoscopy (CE) is 1 diagnostic modality that is used to determine the etiology of @entity548 . OBJECTIVES: The objective of this analysis was to review the diagnostic accuracy, safety, and impact on health outcomes of CE in @entity1 with OGIB in comparison with other diagnostic modalities. DATA SOURCES: A literature search was performed using Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid Embase, the Wiley Cochrane Library, and the Centre for Reviews and Dissemination database, for studies published between 2007 and 2013. REVIEW METHODS: Data on diagnostic accuracy, safety, and impact on health outcomes were abstracted from included studies. Quality of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). RESULTS: The search yielded 1,189 citations, and 24 studies were included. Eight studies reported diagnostic accuracy comparing CE with other diagnostic modalities. Capsule endoscopy has a higher sensitivity and lower specificity than magnetic resonance enteroclysis, computed tomography, and push enteroscopy. Capsule endoscopy has a good safety profile with few adverse events, although comparative safety data with other diagnostic modalities are limited. Capsule endoscopy is associated with no difference in @entity1 health-related outcomes such as rebleeding or follow-up treatment compared with push enteroscopy, small-bowel follow-through, and angiography. LIMITATIONS: There was significant heterogeneity in estimates of diagnostic accuracy, which prohibited a statistical summary of findings. The analysis was also limited by the fact that there is no established reference standard to which the diagnostic accuracy of CE can be compared. CONCLUSIONS: There is very-low-quality evidence that CE has a higher sensitivity but a lower specificity than other diagnostic modalities. Capsule endoscopy has few adverse events, with capsule retention being the most serious complication. Capsule endoscopy is perceived by @entity1 as less @entity158 and less burdensome compared with other modalities. There is low-quality evidence that @entity1 who undergo CE have similar rates of rebleeding, further therapeutic interventions, and hospitalization compared with other diagnostic modalities.
