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

Pablo Cortegoso Valdivia, Karolina Skonieczna-Żydecka, Marco Pennazio, Emanuele Rondonotti, Wojciech Marlicz, Ervin Toth, Anastasios Koulaouzidis, Pablo Cortegoso Valdivia, Karolina Skonieczna-Żydecka, Marco Pennazio, Emanuele Rondonotti, Wojciech Marlicz, Ervin Toth, Anastasios Koulaouzidis

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.

Conflict of interest statement

Competing interests Dr. Emanuele Rondonotti received speaker honoraria from Fujifilm co.

The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Figures

Fig. 1
Fig. 1
Consort diagram of this systematic review.
Fig. 2
Fig. 2
A schematic representation of cut-offs of time- and progression-based indices and their respective papers presented in this review.
Fig. 3
Fig. 3
The current software for RAPID with the progress indicator.

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