Clinical usefulness of transabdominal ultrasonography prior to patency capsule for suspected small-bowel strictures

Objective: Patency capsule (PC) examination has made it possible to perform capsule endoscopy (CE) in patients with a suspected small-bowel stricture. However, PC has some drawbacks, so we assessed the usefulness of transabdominal ultrasonography (TUS) prior to PC in patients with suspected small-bowel strictures to avoid unnecessary PC examination. Patients and methods: Fifty-two patients who underwent TUS prior to PC were enrolled in this study. TUS findings were classified as follows: intestinal narrowing and distension at the oral side (Type A); extensive bowel wall thickening (Type B); focal bowel wall thickening (Type C) or no abnormality detected (Type D). We evaluated the TUS and PC findings for the detection of small-bowel strictures. Results: Double-balloon endoscopy (DBE) revealed small-bowel strictures in 13 of 50 patients (26%). TUS yielded Type B or C findings in 12 of 13 patients (92%), while PC revealed strictures in all 13 patients. In Crohn’s disease (CD) patients with Type B TUS findings, 8 of 9 (89%) had small-bowel strictures on DBE. However, only two of six non-CD patients (33%) with Type B TUS findings had small-bowel strictures. The incidence of Type B strictures was significantly higher in CD patients. Conclusions: CD patients with Type B TUS findings should not undergo PC or CE because of the high rate of small-bowel strictures. Non-CD patients diagnosed with Type B TUS strictures, as well as patients diagnosed with Type C or D strictures should undergo CE after confirming small-bowel patency using PC.     

CECDAIic – a new useful tool in pan-intestinal evaluation of Crohn’s disease patients in the era of mucosal healing

Abstract

Background: Pan-intestinal capsule endoscopy (Pan-CE) has been used to assess both the small and large bowel inflammation in Crohn’s disease (CD) patients in a single examination. The capsule endoscopy Crohn’s disease activity index (CECDAI) was initially developed to measure mucosal disease activity in the small bowel, although in 2018, it was extended to the colon for standardization of inflammatory activity (CECDAIic). The aim of this study was to apply the CECDAIic in a cohort of CD patients that underwent Pan-CE to evaluate the inter-observer agreement and the correlation between this score and inflammatory parameters.

Methods: The videos were read and scored using the CECDAIic by three independent experienced operators, blinded to the results of the standard workup. Statistical analysis was performed with SPSS^®, using Kendall’s coefficient to evaluate the inter-observer agreement. Spearman correlation (r_s) was used to access the correlation between the score and inflammatory biomarkers.

Results: Included 22 patients, 59.1% males with mean age of 30.7?±?11.1 years. The median CECDAIic score was 9.17 (0–37). The overall CECDAIic score Kendall coefficient was 0.94, demonstrating a statistically significant (p?<?.001) and excellent agreement between the three observers. In addition, we found a very good correlation between CECDAIic and calprotectin (r_s?=?0.82; p?=?.012) and a moderate correlation with C-reactive protein (CRP, r_s?=?0.50; p?=?.019).

Conclusions: CECDAIic is a new score with excellent inter-observer agreement and strong correlation with calprotectin levels.     

A comparison between capsule endoscopy and double balloon enteroscopy using propensity score-matching analysis in patients with previous obscure gastrointestinal bleeding

Background: Recently, diagnosis of obscure gastrointestinal bleeding (OGIB) has improved greatly due to introduction of capsule endoscopy (CE) and double balloon enteroscopy (DBE). However, the efficacy of CE over DBE in patients with previous OGIB remains unclear. This study aimed to compare, in terms of diagnostic yield, the efficacy of DBE with that of CE in patients with previous OGIB.

Patients and methods: We enrolled 223 consecutive patients with previous OGIB who were treated between May 2007 and March 2012. We retrospectively evaluated the respective diagnostic yields of CE and DBE in patients with previous OGIB using propensity score-matching analysis. We compared the diagnostic yield of CE with that of DBE.

Results: The diagnostic yields were 41.9% in DBE group and 11.6% in CE group, respectively (p?<?.01). On logistic regression analysis, DBE was significantly superior to CE after matching (Odds ratio [OR], 4.25; 95% confidence interval [CI], 1.43–12.6; p?<?.01), even after adjustment for propensity score (OR, 5.65; 95% CI, 1.56?20.5; p?<?.01).

Conclusions: Our results indicate that DBE might be more useful and perhaps safer than CE in achieving a positive diagnosis in patients with previous OGIB.     

A prospective, single-blind trial comparing wireless capsule endoscopy and double-balloon enteroscopy in patients with obscure gastrointestinal bleeding

BACKGROUND: Wireless capsule endoscopy (CE) and double-balloon enteroscopy (DBE) are new methods enabling diagnostic endoscopy of the entire small intestine. However, which of the two is superior is unclear. We therefore prospectively compared the clinical efficacy of CE and DBE. METHODS: We prospectively examined 32 patients with obscure gastrointestinal bleeding. CE preceded DBE by 1-7 days, and all patients underwent DBE twice, by antegrade and retrograde approaches, to evaluate the entire small intestine. Physicians evaluating the results of CE and DBE were blind to the results of the other method. We evaluated diagnosis, diagnostic yield of the two methods, and clinical outcomes. RESULTS: CE revealed abnormal findings in 29 (90.6%) of 32 patients. CE definitively or probably detected the sources of bleeding in 23 (71.9%) of the 32 patients, including angioectasias (eight), erosions (seven), ulcers (five), tumor (one), and hemorrhagic polyps (two). DBE definitely or probably detected the sources of bleeding in 21 (65.6%) of the 32 patients, including angioectasias (seven), erosions (four), ulcers (five), tumor (one), hemorrhagic polyps (two) and diverticula (two). CE yielded more abnormal findings than DBE (CE 90.6%, DBE 65.6%) (P = 0.032), although there were no significant differences in diagnostic yield between the methods. We were able to perform additional treatment or biopsy with DBE in 13 patients, including coagulation therapy (ten), endoscopic mucosal resection (one), biopsy (seven), and extraction of retained CE (two). CONCLUSIONS: Our results demonstrate the superiority of CE in detecting abnormal lesions, and the superiority of DBE in endoscopic management.     

Simplify to improve in capsule endoscopy – TOP 100 is a swift and reliable evaluation tool for the small bowel inflammatory activity in Crohn’s disease

Abstract

Background: Capsule endoscopy is a widely recognized method to study the small bowel, including in patients with Crohn’s disease (CD). The Lewis score (LS) is a valuable tool in this setting, able to assess inflammatory activity. TOP100, a new software tool of the RAPID Reader^®, emerged to assist in the time-consuming capsule reading process, by automatically selecting 100 images that will most likely contain abnormalities.

Aim: Evaluate the agreement between TOP100 and classic reading (CR) in determining LS in the setting of CD.

Methods: Retrospective study including consecutive patients undergoing small bowel capsule endoscopy (SBCE) for suspected or established CD. One experienced reader performed CR and calculated the LS. Another experienced reader, blinded to the CR results, reviewed all SBCE videos using TOP100 and calculated the LS.

Results: One hundred and fifteen patients were included. SBCE detected significant inflammatory activity (LS ≥135) in 64 patients (55.7%). We verified a strong agreement between the two methods of capsule reading (Kappa = 0.83, p?<?.001), with an agreement on 89.6% of the cases. The agreement was superior in moderate-to-severe inflammatory activity (Kappa = 0.92, p?<?.001). All cases of moderate-to-severe activity detected by CR were identified by TOP100 as significant inflammatory activity. A good agreement was verified in all tertiles (p?<?.001).

Conclusions: Although the classical review of the entire video remains the gold standard, the TOP100 has been shown to be a useful tool in assisting the reader in a prompt calculation of LS, in particular for identifying patients with moderate-to-severe inflammatory disease.     

Repeat capsule endoscopy in suspected gastrointestinal bleeding

Objectives: This study aims to review the utility of repeat capsule endoscopy (CE) with on-going concern of small bowel (SB) bleeding following initial SB investigation with CE.

Materials and methods: A specifically designed database of CE examinations performed over 13 years, with hospital records, was retrospectively interrogated for patients undergoing multiple CEs to investigate iron deficiency anaemia (IDA) or suspected SB bleeding.

Results: 1335/2276 (58.7%) of CEs were performed to investigate IDA or SB bleeding; 92 were repeat CEs carried out for ongoing clinical concern. The median time interval between initial and repeat CE procedures was 466.5 (range 1–3066) days. Twenty-four patients had initially normal CE; on repeat examination, abnormalities were detected in 11/24 (45.8%). 3/21 (14.2%) of patients with angioectasia on first CE had alternative causes for IDA or GI bleeding detected on repeat CE. Six patients with active bleeding, without an identifiable source on initial CE, undergoing repeat CE had a cause isolated in 5/6 (83.3%). Changing CE device did not affect diagnostic yield (DY) compared to repeat CE using the same device (27.5% to 26.8%).

Conclusions: It is known that CE can miss clinically relevant and serious lesions. Our results suggest that patients with an initially negative or inconclusive CE frequently have a cause of SB bleeding detected on repeat CE. The DY of repeat CE is highest in those with bleeding on their initial CE (83.3%) and lower in those with initially normal examinations (45.8%) or when an alternative cause, such as angioectasia is seen (14.2%).     

Pan-intestinal capsule endoscopy in patients with postoperative Crohn's disease: a pilot study

Background: Patients are at increased risk of disease recurrence after surgical treatment of Crohn’s disease. Endoscopic detection of postoperative, ileo-colonic inflammation is well established, but the potential of pan-intestinal endoscopy is yet unknown.

Methods: This prospective multicenter pilot study assessed the value of pan-intestinal capsule endoscopy using a colon capsule endoscope for the detection of inflammatory recurrence of Crohn´s disease. Patients who had been operatively treated for Crohn´s disease were included. Colon capsule endoscopy was performed 4–8 weeks (d1) and 4–8 months (d2) postoperatively together with ileo-colonoscopy at d2 using a modified Ruttgeerts index for evaluating disease activity.

Results: Twenty-two patients were included into this study. At d1, significant disease activity (Ruttgeerts index ≥2) was detected in 3/16 (19%) of the patients. At d2, half of the patients (6/12) showed active disease, whereas ileo-colonoscopy revealed significant inflammation in 5/15 (33%). All patients rated as having active disease by ileo-colonoscopy had been revealed by PICE as well. These findings influenced the medical treatment in every case.

Conclusion: Pan-intestinal capsule endoscopy seems to be feasible in the postoperative surveillance of Crohn's disease. Disease activity is reliably detected. Especially, the findings in the small bowl might be a significant advantage in comparison to ileo-colonoscopy, as they can have significant impact on clinical management. Further studies with a larger number of patients are needed to confirm these findings and might lead to a replacement of the flexible ileo-colonoscopy with pan-intestinal capsule endoscopy in this indication in the future.     

Small bowel video capsule endoscopy in Crohn’s disease: What have we learned in the last ten years?

Since its introduction in 2001, capsule endoscopy (CE) has become the most important advance in the study of small bowel disease, including Crohn’s disease (CD). This technique has been demonstrated to be superior to all other current forms of radiological investigation in detecting mucosal abnormalities of small bowel nonstricturing CD. CE has proven to be extremely useful in diagnosing CD in patients with inconclusive findings from ileocolonoscopy and x-ray-based studies. Almost half of all patients with CD involving the ileum also present lesions in proximal intestinal segments, with the small bowel being exclusively involved in up to 30% of all CD cases. Despite the widespread use of CE, several questions concerning the utility of this technique remain unanswered. The lack of commonly agreed diagnostic criteria for defining CD lesions with the aid of CE may have had an influence on the variation in diagnostic re sults for CE reported in the literature. The utility of CE in monitoring CD and in guiding therapy has also been proposed. Furthermore, CE could be a useful second-line technique for patients with an established diagn osis of CD and unexplained symptoms. Finally, as no thres hold for CD diagnosis has been agreed upon, a se verity scale of mucosal disease activity has notbeen universally followed. None of the available activity indexes based on CE findings has been independently validated. This article discusses several cutting-edge aspects of the usefulness of CE in CD 10 years after its introduction as a sensible method to study the small intestine.     

Use of the Given Patency System for the screening of patients at high risk for capsule retention

BACKGROUND: Capsule enteroscopy is a non-invasive diagnostic tool for the study of the small bowel. Due to the risk of capsule retention, capsule enteroscopy is contraindicated in patients with suspected small bowel strictures. The Given Patency Capsule is a disintegration time-controlled capsule developed to identify patients with strictures that may cause capsule enteroscopy retention. The presence of the patency capsule within the patient's body can be detected by a radio-frequency scanner. AIM OF THE STUDY: To evaluate safety and usefulness of the patency capsule in preventing capsule retention in patients at high risk. PATIENTS AND METHODS: Thirty-two patients were studied. Indications for patency capsule were: (A) Crohn's disease (18), (B) previous intestinal surgery (7), (C) previous obstruction (1), A+B (3), A+C (1), B+C (2). Patients were evaluated with the scanner at 72 h from ingestion. RESULTS: At 72 h, 24 patients had already excreted the intact capsule in the stool. Of these, two experienced abdominal pain during capsule passage. In the other eight patients, the scanner detected the presence of the patency capsule. Four of them excreted the capsule intact in the stool after 72-96 h, the remaining four never found the capsule in the stool. The 26 patients who excreted the patency capsule intact without experiencing abdominal pain were deemed eligible for the capsule enteroscopy procedure, which was performed uneventfully in the 25 who agreed to undergo the examination. CONCLUSIONS: The patency capsule is useful to identify, among patients at high risk, those who can be submitted to capsule enteroscopy without risks of capsule retention.     

胶囊内镜滞留临床特征及处置策略

目的探讨胶囊内镜滞留的临床特征及处理。方法回顾性分析2008年9月-2013年9月行胶囊内镜检查中出现胶囊滞留的病例特征。结果 559例胶囊内镜检查中,共发生胶囊滞留11例,发生率为2.0%,9例为克罗恩病,2例为小肠肿瘤;其中2例因并发肠梗阻、1例并发消化道穿孔行手术治疗,1例小肠镜下取出胶囊,1例4个月后自行排出,4例仍在继续随访中,无胶囊滞留相关的死亡病例。结论胶囊滞留是胶囊内镜检查中较严重并发症,应尽可能在内镜下取出胶囊或行手术治疗。     

小肠克罗恩病54例临床特征分析

目的分析小肠克罗恩病患者的临床资料,增进对小肠克罗恩病的认识。方法回顾性归纳2004年01月至2008年12月期间南方医院小肠克罗恩病患者的临床表现、消化道内镜、腹部影像学及病理等相关资料。结果小肠克罗恩病患者共54例,青壮年好发[发病年龄(28.9±11.8)岁],病程较长[(35.6±46.6)月],临床表现以腹痛、营养不良、黑便等为主,并发症以肠梗阻、瘘管形成、消化道大出血等多见。小肠克罗恩病主要以黏膜破损、肠腔狭窄等为主要病变形态,节段、跳跃式分布于小肠各部位,空肠、回肠(回肠末端除外)、回肠末端(和/或回盲瓣)受累比例为48.6%、77.1%、62.9%。23例(42.6%)具有上皮样细胞、非干酪性坏死性肉芽肿等特征性病理发现。结论小肠克罗恩病临床表现多样,小肠段内镜探查是小肠克罗恩病的首选手段;目前小肠克罗恩病诊断仍较困难,需结合临床表现、影像学和消化内镜证据以及病理、追踪资料等综合判断。     

胶囊内镜结合双气囊内镜检查在小肠疾病诊断中的作用

目的 探讨胶囊内镜结合双气囊内镜检查在小肠疾病诊断中的作用.方法 连续调查299例因不明原因消化道出血或腹痛、腹泻等原因而行胶囊内镜检查者,对胶囊内镜阴性或诊断不确定者建议双气囊内镜检查.分析胶囊内镜后双气囊内镜检查者诊断和随访资料.结果 296例完成胶囊内镜检查,发现阳性138例(46.6%),可疑阳性68例(23.0%),阴性90例(30.4%).45例胶囊内镜可疑阳性者和7例阴性者接受双气囊内镜检查,分别检出31例和1例小肠病变.双气囊内镜可能存在假阴性结果8例,未发现假阳性者;胶囊内镜可能存在假阴性结果2例,并有8例假阳性.在胶囊内镜结果提示下,90.3%(28/31)患者经单侧双气囊内镜检查即发现病灶.平均随访期为17个月,93.5%的双气囊内镜明确诊断者得到有效治疗.二种检查方法耐受性好,无严重不良反应发生.结论 胶囊内镜对小肠病变检出率高,但其诊断不确定性也较高.双气囊内镜能明确大部分胶囊内镜可疑阳性者.胶囊内镜结合双气囊内镜检查的诊断策略能提高小肠疾病诊断率、指导治疗并改善患者预后.     

10 years of capsule endoscopy: an update

Capsule endoscopy (CE) has evolved in a few short years to become a first-line, noninvasive diagnostic technique for the small bowel. CE is now being utilized worldwide to assess patients for obscure gastrointestinal bleeding, possible Crohn’s disease, celiac disease and small bowel tumors. The device is now used in tandem with balloon enteroscopy to direct therapeutic interventions. Alterations and improvements in CE have also led to the evaluation of both the esophagus and colon. It can be anticipated that in the near future pan CE of the entire GI tract will be performed, as well as possible tissue acquisition, drug delivery and therapeutic interventions.     

A meta-analysis of the yield of capsule endoscopy compared to double-balloon enteroscopy in patients with small bowel diseases

AIM To compare the diagnostic yield of capsule endoscopy(CE) with that of double-balloon enteroscopy (DBE).METHODS Pubmed, Embase, Elsevier ScienceDirect,the China Academic Journals Full-text Database, and Cochrane Controlled Trials Register were searched for the trials comparing the yield of CE with that of DBE.Outcome measure was odds ratio (OR) of the yield. Fixed or random model method was used for data analysis.RESULTS Eight studies (n = 277) which prospectively compared the yield of CE and DBE were collected. The results of meta-analysis indicated that there was no difference between the yield of CE and DBE [170/277 vs 156/277, OR 1.21 (95% CI 0.64-2.29)]. Based on sub analysis, the yield of CE was significantly higher than that of double-balloon enteroscopy without combination of oral and anal insertion approaches [137/219 vs 110/219, OR 1.67 (95% CI 1.14-2.44), P ＜ 0.01), but not superior to the yield of DBE with combination of the two insertion approaches [26/48 vs 37/48, OR 0.33 (95% CI 0.05-2.21), P ＞ 0.05)]. A focused meta-analysis of the fully published articles concerning obscure GI bleeding was also performed and showed similar results wherein the yield of CE was significantly higher than that of DBE without combination of oral and anal insertion approaches [118/191 vs 96/191, fixed model OR 1.61(95% CI 1.07-2.43), P ＜0.05)] and the yield of CE was significantly lower than that of DBE by oral and anal combinatory approaches [11/24 vs 21/24, fixed modelOR 0.12 (95% CI 0.03-0.52), P ＜ 0.01)].CONCLUSION With combination of oral and anal approaches, the yield of DBE might be at least as high as that of CE. Decisions made regarding the initial approach should depend on patient's physical status, technology availability, patient's preferences, and potential for therapeutic endoscopy.     

胶囊内镜检查胃肠疾病116例的临床分析

目的评价胶囊内镜对不同消化道症状并疑似小肠疾病患者的应用价值。方法对我院2010年8月至2012年6月期间进行胶囊内镜检查的116例患者的临床资料进行回顾性分析。结果 116例患者完成胶囊内镜检查116例,共行116次检查,阳性检出率53.5%(62/116)。共发现小肠病变49例,小肠病变阳性率为42.2%(49/116),其中82例腹痛患者发现小肠病变33例(40.2%),12例腹泻患者发现小肠病变4例(33.3%),17例消化道出血患者发现小肠病变12例(70.6%)。其中炎性病变、隆起性病变最为常见。9例患者胶囊内镜胃内通过迟缓,1例患者胶囊内镜完全停滞于胃内,未至小肠,直至电池耗竭;3例胶囊内镜通过小肠迟缓;胶囊内镜在小肠内运行平均时间为369min。检查过程中患者无任何不适。结论胶囊内镜对不同消化道症状并疑似小肠疾病的就诊患者均有较好的诊断价值,简单、安全,并发症及风险小,依从性好。检查前充分肠道准备可提高检查质量。     

Screening pre-bariatric surgery patients for esophageal disease with esophageal capsule endoscopy

AIM:To determine if esophageal capsule endoscopy(ECE)is an adequate diagnostic alternative to esophagogastroduodenoscopy(EGD)in pre-bariatric surgery patients.METHODS:We conducted a prospective pilot study to assess the diagnostic accuracy of ECE(PillCam ESO2,Given Imaging)vs conventional EGD in pre-bariatric surgery patients.Patients who were scheduled for bariatric surgery and referred for pre-operative EGD were prospectively enrolled.All patients underwent ECE followed by standard EGD.Two experienced gastroenterologists blinded to the patient’s history and the findings of the EGD reviewed the ECE and documented their findings.The gold standard was the findings on EGD.RESULTS:Ten patients with an average body mass index of 50 kg/m2were enrolled and completed the study.ECE identified 11 of 14(79%)positive esophageal/gastroesophageal junction(GEJ)findings and 14of 17(82%)combined esophageal and gastric findings identified on EGD.Fisher’s exact test was used to compare the findings and no significant difference was found between ECE and EGD(P=0.64 for esophageal/GEJ and P=0.66 for combined esophageal and gastric findings respectively).Of the positive esophageal/GEJ findings,ECE failed to identify the following:hiatal hernia in two patients,mild esophagitis in two patients,and mild Schatzki ring in two patients.ECE was able to identify the entire esophagus in 100%,gastric cardia in0%,gastric body in 100%,gastric antrum in 70%,pylorus in 60%,and duodenum in 0%.CONCLUSION:There were no significant differences in the likelihood of identifying a positive finding using ECE compared with EGD in preoperative evaluation of bariatric patients.     

Five years＇experience with capsule endoscopy in a single center

Capsule endoscopy （CE） is a novel technology that facilitates highly effective and noninvasive imaging of the small bowel. Although its efficacy in the evaluation of obscure gastrointestinal bleeding （OGIB） has been proven in several trials, data on uses of CE in different small bowel diseases are rapidly accumulating in the literature, and it has been found to be superior to alternative diagnostic tools in a range of such diseases. Based on literature evidence, CE is recommended as a first-line investigation for OGIB after negative bidirectional endoscopy. CE has gained an important role in the diagnosis and follow-up of Crohn＇s disease and celiac disease and in the surveillance of small bowel tumors and polyps in selected patients. Capsule retention is the major complication, with a frequency of 1%-2%. The purpose of this review was to discuss the procedure, indications, contraindications and adverse effects associated with CE. We also review and share our five-year experience with CE in various small bowel diseases. The recently developed balloon-assisted enteroscopies have both diagnostic and therapeutic capability. At the present time, CE and balloon-assisted enteroscopies are complementary techniques in the diagnosis and management of small bowel diseases.     

Perianal Crohn’s disease – association with significant inflammatory activity in proximal small bowel segments

Objectives: Perianal Crohn’s disease (CD) prevalence varies according to the disease location, being particularly frequent in patients with colonic involvement. We aimed to evaluate small bowel involvement and compare small bowel capsule endoscopy findings and inflammatory activity between patients with and without perianal disease.

Materials and methods: Retrospective single-center study including 71 patients – all patients with perianal CD (17 patients) who performed a small bowel capsule endoscopy were included, and non-perianal CD patients were randomly selected (54 patients). Clinical and analytical variables at diagnosis were reviewed. Statistical analysis was performed with SPSS v21.0 and a two-tailed p value <.05 was defined as indicating statistical significance.

Results: Patients had a median age of 30?±?16 years with 52.1% females. Perianal disease was present in 23.9%. Patients with perianal disease had significantly more relevant findings (94.1% vs 66.6%, p?=?.03) and erosions (70.6% vs 42.6%, p?=?.04), however, no differences were found between the two groups regarding ulcer, villous edema and stenosis detection. Overall, patients with perianal disease had more frequently significant small bowel inflammatory activity, defined as a Lewis Score?≥135 (94.1% vs 64.8%, p?=?.03), and higher Lewis scores in the first and second tertiles (450?±?1129 vs 0?±?169, p?=?.02 and 675?±?1941 vs 0?±?478, p?=?.04, respectively). No differences were found between the two groups regarding third tertile inflammatory activity assessed with the Lewis Score.

Conclusion: Patients with perianal CD have significantly higher inflammatory activity in the small bowel, particularly in proximal small bowel segments, when compared with patients without perianal disease.     

胶囊内镜指导双气囊内镜进镜方式的临床研究

目的评估小肠疾病诊治中胶囊内镜（CE）对双气囊内镜（DBE）进镜方式的预测作用。方法将CE完成全小肠检查且其诊断经DBE证实者纳入研究。CE检出病灶的部位以时间指数（胶囊从幽门至病灶的通过时间占胶囊从幽门至回盲瓣通过时间的比例）表示,根据以往回顾性分析的结果采用0．6作为时间指数的临界值,时间指数不超过0．6时选择经口DBE检查,反之选择经肛检查。对最终结果进行统计学分析,评估根据病灶部位cE时间指数选择DBE进镜方式的准确性。结果最终共60例患者CE完成全小肠检查且其诊断经DBE证实而纳入研究。共行60例次DBE检查,包括41例经口和19例经肛检查,所有患者CE检出病灶均经首次DBE检查证实。对所得结果进行统计显示,根据cE时间指数临界值0．6,本组患者DBE进镜方式选择的准确性为100％。结论DBE是一项有效地证实CE诊断的方法,在cE完成全小肠检查者中根据CE时间指数能够准确判断DBE的进镜方式。