Completion small bowel capsule endoscopy after device-assisted enteroscopy in management of patients with small bowel disease

Background and study aims: Diagnostic yield of small bowel capsule endoscopy (SBCE) and device-assisted enteroscopy (DAE) are known to be similar. SBCE is normally recommended as the initial diagnostic test, with DAE reserved for therapeutic indications. Because most DAE procedures are not pan-enteric, a completion capsule may be of benefit to identify residual or overlooked disease. Our aim was to assess clinical utility of completion SBCE performed following DAE. Patients and methods: A retrospective analysis of completion capsules post double balloon enteroscopy (DBE) from a single referral center was performed. Cases were identified by cross-referencing endoscopy and capsule databases. A completion capsule was defined as a capsule endoscopy requested on the enteroscopy report and performed after DAE without a new clinical indication. Main outcome measures included diagnostic yield of completion SBCE and impact on management. Results: Of 350 DBE cases, 70 (21%) underwent a completion SBCE, 27 of 70 (39%) on the same day as DBE. In all, 39 of 70 (56%) had undergone SBCE before DBE. Both completion rate (91%; 64/70) and diagnostic yield (43%; 30/70) surpassed European Sociey of Gastrointestinal Endoscopy standards. A positive completion capsule resulted in a change in management in 80% of patients (24/30). Conclusions: Completion SBCE is feasible and effective, detecting and localizing clinically significant disease in over one-third of cases while also reducing need for further investigations in those with negative studies.