Digestive Diseases and Sciences

, Volume 60, Issue 12, pp 3716–3720 | Cite as

Capsule Studies Performed in a Tertiary Care Center Versus Community Referrals Prior to Single-Balloon Enteroscopy: Does It Matter?

  • Andrea C. Rodriguez
  • Ashok Shiani
  • Seth Lipka
  • Kirbylee K. Nelson
  • Ashley H. Davis-Yadley
  • Roshanak Rabbanifard
  • Ambuj Kumar
  • Patrick G. Brady
Original Article


Background and Aims

Within the community, patients with positive capsule endoscopy (CE) are often referred to centers performing balloon-assisted enteroscopy. There is limited data evaluating the concordance and diagnostic/therapeutic yield of CE performed in the community versus CE conducted at institutions experienced with enteroscopy. The primary aim of this retrospective study was to evaluate the concordance between CE and SBE after CE was performed either in the community or at our tertiary care center.


A total of 141 patients were analyzed after selecting patients undergoing evaluation of obscure GI bleeding from January 2010 to May 2014. Forty-seven CE were performed inside and the remaining 94 CE were performed at outside institutions prior to single-balloon enteroscopy at our institution. Agreement beyond chance was evaluated using kappa coefficient. A p value <5 % was considered significant.


The most frequent findings on CE were vascular lesions in 39 patients (41.5 %) within the referral group and 23 within inside patients (48.9 %), followed by active bleeding/clots in 23 patients (24.5 %) and in 14 patients (29.8 %) respectively. There was a fair degree of concordance in the referral group for vascular lesions 0.23 (0.03–0.42) compared to a good degree in the inside group 0.65 (0.44–0.87). Fair agreement was found looking at ulcers within the referral group 0.29 (0.06–0.65) compared to a moderate agreement in the inside group 0.55 (0.17–0.94).


Degree of concordance for vascular lesions and ulcers was significantly higher for patients undergoing CE at our institution compared to those referred from the community. Patients referred to tertiary care centers for balloon-assisted enteroscopy may benefit from advanced endoscopists re-reading the capsule findings or even potentially repeating CE in hemodynamically stable patients if the study is not available.


Single-balloon enteroscopy Balloon-assisted enteroscopy Concordance Capsule endoscopy Obscure gastrointestinal bleeding Occult Obscure 



This manuscript did not receive any funding from any organization. All the authors contributed equally to the manuscript.

Compliance with Ethical Standards

Conflicts of interest

None of the authors cited above have any reported conflict of interest.


  1. 1.
    Fisher L, Lee Krinsky M, Anderson MA, et al. The role of endoscopy in the management of obscure GI bleeding. Gastrointest Endosc. 2010;72:471–479.CrossRefPubMedGoogle Scholar
  2. 2.
    Byeon JS, Mann NK, Jamil LH, Lo SK. Is a repeat double balloon endoscopy in the same direction useful in patients with recurrent obscure gastrointestinal bleeding? J Clin Gastroenterol. 2013;47:496–500.CrossRefPubMedGoogle Scholar
  3. 3.
    Raju GS, Gerson L, Das A, Lewis B. American Gastroenterological Association (AGA) Institute technical review on obscure gastrointestinal bleeding. Gastroenterology. 2007;133:1697–1717.CrossRefPubMedGoogle Scholar
  4. 4.
    Goenka MK, Majumder S, Goenka U. Capsule endoscopy: present status and future expectation. World J Gastroenterol WJG. 2014;20:10024–10037.CrossRefPubMedGoogle Scholar
  5. 5.
    Gralnek IM. Obscure-overt gastrointestinal bleeding. Gastroenterology. 2005;128:1424–1430.CrossRefPubMedGoogle Scholar
  6. 6.
    Iddan G, Meron G, Glukhovsky A, Swain P. Wireless capsule endoscopy. Nature. 2000;405:417.CrossRefPubMedGoogle Scholar
  7. 7.
    Tsujikawa T, Saitoh Y, Andoh A, et al. Novel single-balloon enteroscopy for diagnosis and treatment of the small intestine: preliminary experiences. Endoscopy. 2008;40:11–15.CrossRefPubMedGoogle Scholar
  8. 8.
    Kawamura T, Yasuda K, Tanaka K, et al. Clinical evaluation of a newly developed single balloon enteroscope. Gastrointest Endosc. 2008;68:1112–1116.CrossRefPubMedGoogle Scholar
  9. 9.
    Prachayakul V, Deesomsak M, Aswakul P, Leelakusolvong S. The utility of single-balloon enteroscopy for the diagnosis and management of small bowel disorders according to their clinical manifestations: a retrospective review. BMC Gastroenterol. 2013;13:103.PubMedCentralCrossRefPubMedGoogle Scholar
  10. 10.
    Ramchandani M, Reddy DN, Gupta R, et al. Diagnostic yield and therapeutic impact of single-balloon enteroscopy: series of 106 cases. J Gastroenterol Hepatol. 2009;24:1631–1638.CrossRefPubMedGoogle Scholar
  11. 11.
    Nakamura M, Niwa Y, Ohmiya N, et al. Preliminary comparison of capsule endoscopy and double-balloon enteroscopy in patients with suspected small-bowel bleeding. Endoscopy. 2006;38:59–66.CrossRefPubMedGoogle Scholar
  12. 12.
    May A, Farber M, Aschmoneit I, et al. Prospective multicenter trial comparing push-and pull enteroscopy with the single- and double-balloon techniques in patients with small-bowel disorders. Am J Gastroenterol. 2010;105:575–581.CrossRefPubMedGoogle Scholar
  13. 13.
    Sethi S, Cohen J, Thaker AM, et al. Prior capsule endoscopy improves the diagnostic and therapeutic yield of single-balloon enteroscopy. Dig Dis Sci. 2014;59:2497–2502.CrossRefPubMedGoogle Scholar
  14. 14.
    Byrt T, Bishop J, Carlin JB. Bias, prevalence and kappa. J Clin Epidemiol. 1993;46:423–429.CrossRefPubMedGoogle Scholar
  15. 15.
    Szold A, Katz LB, Lewis BS. Surgical approach to occult gastrointestinal bleeding. Am J Surg. 1992;163:90–92. discussion 2–3.CrossRefPubMedGoogle Scholar
  16. 16.
    Koulaouzidis A, Rondonotti E, Karargyris A. Small-bowel capsule endoscopy: a ten-point contemporary review. World J Gastroenterol WJG. 2013;19:3726–3746.CrossRefPubMedGoogle Scholar
  17. 17.
    Zhang BL, Chen CX, Li YM. Capsule endoscopy examination identifies different leading causes of obscure gastrointestinal bleeding in patients of different ages. Turk J Gastroenterol. 2012;23:220–225.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Andrea C. Rodriguez
    • 1
  • Ashok Shiani
    • 1
  • Seth Lipka
    • 2
  • Kirbylee K. Nelson
    • 1
  • Ashley H. Davis-Yadley
    • 1
  • Roshanak Rabbanifard
    • 2
  • Ambuj Kumar
    • 3
  • Patrick G. Brady
    • 2
  1. 1.Department of Internal MedicineUniversity of South Florida Morsani College of MedicineTampaUSA
  2. 2.Digestive Diseases and NutritionUniversity of South Florida Morsani College of MedicineTampaUSA
  3. 3.Evidence Based MedicineUniversity of South Florida Morsani College of MedicineTampaUSA

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