Clinically significant small-bowel pathology identified by double-balloon enteroscopy but missed by capsule endoscopy

BackgroundCapsule endoscopy (CE) is increasingly being used to investigate the small bowel for various indications, including obscure GI bleeding (OGB). However, false negatives have been described. Double-balloon enteroscopy (DBE) is a new endoscopic technique developed to potentially view the entire small intestine while allowing therapeutic options to be carried out when appropriate.ObjectiveWe described 4 patients with small-bowel pathology missed on CE but detected by DBE.DesignDescriptive retrospective study. All patients underwent CE followed by DBE.SettingSingle-center tertiary referral hospital.PatientsFour patients were included. Three patients had OGB that required blood transfusions. One patient with celiac disease, compliant on a strict gluten-free diet for 5 months, presented with persistent weight loss and abdominal pain.InterventionsDBE followed by surgical exploration and resection of small-bowel pathology.Main Outcome MeasurementsSuccessful identification of pathology missed by CE. Definitive treatment of small-bowel pathology by surgical resection.ResultsCE did not identify the small-bowel pathology in all 4 patients. The 3 patients with OGB had small-bowel masses found by DBE. Two of these were GI stromal tumors and one was an adenocarcinoma. The patient with celiac disease had a malignant ulcer, confirmed to be a lymphoma after surgical resection.LimitationsRetrospective study and small sample size.ConclusionsCE and DBE are complementary investigations. If there is a high index of suspicion of small-bowel pathology despite a negative CE, DBE should be performed.