Capsule Endoscopy in Diagnosis of Small Bowel Diseases: An Health Technology Assessment_Chinese Journal of Evidence-Based Medicine

Authors：

 LIXiang-lian ¹ , SHENJian-tong ¹ ,  LIYou-ping ¹ , TANGCheng-wei ² , LICui-cui ¹ , YUJia-jie ¹ , WANGYing-qiang ¹ , YANGZong-xia ¹ , SHICheng-hu ¹ , SUNXin ¹ , HUANGLi-bin ² , for Rapid Health Technology Assessment Working Group of Chinese Evidence-Based Medicine Center

1. Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China;
2. Digestive Department, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding?author：

LIYou-ping, Email: yzmylab@hotmail.com

Keywords：

Capsule endoscopy(CE); Small bowel disease(SBD); Diagnosis; Health technology assessment(HTA)

DOI：

10.7507/1672-2531.20140093

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Objective Capsule endoscopy (CE) has been widely used in the diagnosis of small bowel disease (SBD) in the world. To bring CE into the national health insurance directory, and intensify its popularization in primary hospitals, the government needs high quality health technology assessment (HTA) evidence for decision making. This study was aimed to comprehensively evaluate the effectiveness, safety, applicability and economics of CE in the diagnosis of SBD based on global review, to providing the best currently-available evidence for decision making. Methods We electronically searched The Cochrane Library (Issue 8, September 2013), PubMed, EMbase, INAHTA, VIP, CBM, CNKI and WanFang Data. We screened studies, extracted data, and evaluated quality independently, according to inclusion and exclusion criteria; and then we made final conclusion after comprehensive analysis. Results We finally included 4 HTAs, 11 systematic reviews (SRs)/ Meta-analyses, 2 randomized controlled trials (RCTs), 5 guidelines, and 10 economics studies for assessment. The results of HTAs, SRs/ meta-analyses and RCTs all showed that, the disease detection rate of CE was higher than that of many other traditional technologies, and that the main adverse event for CE was retention (0.7% to 3.0%), which were consistent with those of the guidelines' recommendations. Besides, the comprehensive results of economics studies showed the superiority of CE compared with other technologies. As the first choice, CE could significantly decrease potential costs, especially when used in outpatients. Conclusion a) Compared with similar technologies, CE indeed has advantages in diagnostic yield, safety and potential costs in the diagnosis of SBD. However, its application has certain limitations, which still needs to be verified by more high quality evidence about CE diagnosis accuracy. b) It is sug gested that, when the government approves the introduction of CE to hospitals, many factors must be considered, such as local disease burden, clinical demands, ability to pay, and staff configuration. At the same time, it is necessary to standardize training for medical technicians, to reduce economic loss caused by poor technical abilities of medicaltechnicians.

Citation： LIXiang-lian, SHENJian-tong, LIYou-ping, TANGCheng-wei, LICui-cui, YUJia-jie, WANGYing-qiang, YANGZong-xia, SHICheng-hu, SUNXin, HUANGLi-bin, for Rapid Health Technology Assessment Working Group of Chinese Evidence-Based Medicine Center. Capsule Endoscopy in Diagnosis of Small Bowel Diseases: An Health Technology Assessment. Chinese Journal of Evidence-Based Medicine, 2014, 14(5): 541-553. doi: 10.7507/1672-2531.20140093 Copy

1.	Fisher LR, Hasler WL. New vision in video capsule endoscopy:current status and future directions. Nat Rev Gastroenterol Hepatol, 2012, 9(7):392-405.
2.	Ladas SD, Triantafyllou K, Spada C, et al. European Society of Gastrointestinal Endoscopy (ESGE):recommendations (2009) on clinical use of video capsule endoscopy to investigate small-bowel, esophageal and colonic diseases. Endoscopy, 2010, 42(3):220-227.
3.	Medical Advisory Secretariat. Wireless capsule endoscopy:an evidence-based analysis. Ont Health Technol Assess Ser, 2003, 3(2):1-35.
4.	Leonor VL, Alberto RR. Effectiveness and safety of capsule endoscopy in the diagnosis of small bowel diseases. J Clin Gastroenterol, 2008, 42(5):466-471.
5.	Alessandra LS, Marco R, Tom J, et al. Wireless capsule endoscopy in Italy:adding context-specific data to the review of the evidence from literature. Int J Technol Assess Health Care, 2009, 25(3):297-304.
6.	Gilbert H, Lewis S, Kimman M. Capsule endoscopy for the diagnosis of suspected small bowel Crohn's disease. MSAC Application 1146. Assessment Report. Commonwealth of Australia, Canberra, ACT, 2011:1-66.
7.	Shea BJ, Hamel C, Wells GA, et al. AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews. J Clin Epidemiol, 2009, 62(10):1313-1020.
8.	Leighton JA, Triester SL, Sharma VK. Capsule endoscopy:a metaanalysis for use with obscure gastrointestinal bleeding and Crohn's disease. Gastrointest Endosc Clin N Am, 2006, 16(2):229-250.
9.	Marmo R, Rotondano G, Piscopo R, et al. Meta-analysis:capsule enteroscopy vs. conventional modalities in diagnosis of small bowel diseases. Aliment Pharmacol Ther, 2005, 22(7):595-604.
10.	Teshima CW, Kuipers EJ, Van Zanten SV, et al. Double balloon enteroscopy and capsule endoscopy for obscure gastrointestinal bleeding:an updated meta-analysis. J Gastroenterol Hepatol, 2011, 26(5):796-801.
11.	朱林林, 王一平. Cte、Ce、Sbft、Mre對小腸克羅恩病的診斷性系統評價.解放軍醫學雜志, 2011, 36(8):848-851.
12.	Dionisio PM, Gurudu SR, Leighton JA, et al. Capsule endoscopy has a significantly higher diagnostic yield in patients with suspected and established small-bowel Crohn's disease:a meta-analysis. Am J Gastroenterol, 2010, 105(6):1240-1248, 1249.
13.	El-Matary W, Huynh H, Vandermeer B. Diagnostic characteristics of given video capsule endoscopy in diagnosis of celiac disease:a metaanalysis. J Laparoendosc Adv Surg Tech A, 2009, 19(6):815-820.
14.	Rokkas T, Niv Y. The role of video capsule endoscopy in the diagnosis of celiac disease:a meta-analysis. Eur J Gastroenterol Hepatol, 2012, 24(3):303-308.
15.	Pasha SF, Leighton JA, Das A, et al. Double-balloon enteroscopy and capsule endoscopy have comparable diagnostic yield in small-bowel disease:a meta-analysis. Clin Gastroenterol Hepatol, 2008, 6(6):671-676.
16.	Chen X, Ran ZH, Tong JL. A meta-analysis of the yield of capsule endoscopy compared to double-balloon enteroscopy in patients with small bowel diseases. World J Gastroenterol, 2007, 13(32):4372-4378.
17.	Cohen SA, Klevens AI. Use of capsule endoscopy in diagnosis and management of pediatric patients, based on meta-analysis. Clin Gastroenterol Hepatol, 2011, 9(6):490-496.
18.	Liao Z, Gao R, Xu C, et al. Indications and detection, completion, and retention rates of small-bowel capsule endoscopy:a systematic review. Gastrointest Endosc, 2010, 71(2):280-286.
19.	de Leusse A, Vahedi K, Edery J, et al. Capsule endoscopy or push enteroscopy for first-line exploration of obscure gastrointestinal bleeding? Gastroenterology, 2007, 132(3):855-862; quiz 1164-1165.
20.	Leung WK, Ho SS, Suen BY, et al. Capsule endoscopy or angiography in patients with acute overt obscure gastrointestinal bleeding: A prospective randomized study with long-term follow-up. Am J Gastroenterol, 2012, 107(9):1370-1376.
21.	Goldfarb NI, Phillips A, Conn M, et al. Economic and health outcomes of capsule endoscopy:Opportunities for improved management of the diagnostic process for obscure gastrointestinal bleeding. Disease Management, 2002, 5(3):123-135.
22.	Somsouk M, Gralnek IM, Inadomi JM. Management of obscure occult gastrointestinal bleeding:a cost-minimization analysis. Clin Gastroenterol Hepatol, 2008, 6(6):661-670.
23.	Albert JG, Nachtigall F, Wiedbrauck F, et al. Minimizing procedural cost in diagnosing small bowel bleeding:comparison of a strategy based on initial capsule endoscopy versus initial double-balloon ent-eroscopy. Eur J Gastroenterol Hepatol, 2010, 22(6):679-688.
24.	Rondonotti E, Soncini M, Girelli C, et al. Cost estimation of small bowel capsule endoscopy based on "real world" data:inpatient or outpatient procedure? Dig Liver Dis, 2010, 42(11):798-802.
25.	戈之錚, 顧靜莉, 高云杰, 等.膠囊內鏡在小腸出血診斷中的效價分析.中華消化雜志, 2007, 27(6):378-381.
26.	Goldfarb NI, Pizzi LT, Fuhr JP Jr, et al. Diagnosing Crohn's disease: an economic analysis comparing wireless capsule endoscopy with traditional diagnostic procedures. Dis Manag, 2004, 7(4):292-304.
27.	Leighton JA, Gralnek IM, Richner RE, et al. Capsule endoscopy in suspected small bowel Crohn's disease:economic impact of disease diagnosis and treatment. World J Gastroenterol, 2009, 15(45):5685-5692.
28.	Levesque BG, Cipriano LE, Chang SL, et al. Cost effectiveness of alternative imaging strategies for the diagnosis of small-bowel Crohn's disease. Clin Gastroenterol Hepatol, 2010, 8(3):261-267.
29.	Nguyen Y, Murad F, Mullady D, et al. Downstream revenue stream from resource intensive small bowel endoscopies (single balloon enteroscopy, spiral balloon enteroscopy, and wireless capsule endoscopy). Gastrointestinal Endoscopy, 2010, 71(5):AB244-AB245.
30.	萬蘋, 范紅, 郭強, 等.膠囊內鏡雙氣囊內鏡單獨與聯合運用對小腸疾病診斷效力的衛生經濟學評價.中國內鏡雜志, 2011, 17(2): 151-156.
31.	Gerber J, Bergwerk A, Fleischer D. A capsule endoscopy guide for the practicing clinician:technology and troubleshooting. Gastrointest Endosc, 2007, 66(6):1188-1195.
32.	Sidhu R, Sanders DS, Morris AJ, et al. Guidelines on small bowel enteroscopy and capsule endoscopy in adults. Gut, 2008, 57(1):125-136.
33.	中華醫學會消化內鏡學分會小腸鏡和膠囊鏡學組.中華消化內鏡學會膠囊內鏡臨床應用規范.中華消化內鏡雜志, 2008, 25(7): 337-338.
34.	Shim KN, Moon JS, Chang DK, et al. Guideline for capsule endoscopy: obscure gastrointestinal bleeding. Clin Endosc, 2013, 46(1):45-53.
35.	Gossum A, Ibrahim M. Video capsule endoscopy:What is the future? Gastroenterol Clin North Am, 2010, 39:807-826.

1. Fisher LR, Hasler WL. New vision in video capsule endoscopy:current status and future directions. Nat Rev Gastroenterol Hepatol, 2012, 9(7):392-405.
2. Ladas SD, Triantafyllou K, Spada C, et al. European Society of Gastrointestinal Endoscopy (ESGE):recommendations (2009) on clinical use of video capsule endoscopy to investigate small-bowel, esophageal and colonic diseases. Endoscopy, 2010, 42(3):220-227.
3. Medical Advisory Secretariat. Wireless capsule endoscopy:an evidence-based analysis. Ont Health Technol Assess Ser, 2003, 3(2):1-35.
4. Leonor VL, Alberto RR. Effectiveness and safety of capsule endoscopy in the diagnosis of small bowel diseases. J Clin Gastroenterol, 2008, 42(5):466-471.
5. Alessandra LS, Marco R, Tom J, et al. Wireless capsule endoscopy in Italy:adding context-specific data to the review of the evidence from literature. Int J Technol Assess Health Care, 2009, 25(3):297-304.
6. Gilbert H, Lewis S, Kimman M. Capsule endoscopy for the diagnosis of suspected small bowel Crohn's disease. MSAC Application 1146. Assessment Report. Commonwealth of Australia, Canberra, ACT, 2011:1-66.
7. Shea BJ, Hamel C, Wells GA, et al. AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews. J Clin Epidemiol, 2009, 62(10):1313-1020.
8. Leighton JA, Triester SL, Sharma VK. Capsule endoscopy:a metaanalysis for use with obscure gastrointestinal bleeding and Crohn's disease. Gastrointest Endosc Clin N Am, 2006, 16(2):229-250.
9. Marmo R, Rotondano G, Piscopo R, et al. Meta-analysis:capsule enteroscopy vs. conventional modalities in diagnosis of small bowel diseases. Aliment Pharmacol Ther, 2005, 22(7):595-604.
10. Teshima CW, Kuipers EJ, Van Zanten SV, et al. Double balloon enteroscopy and capsule endoscopy for obscure gastrointestinal bleeding:an updated meta-analysis. J Gastroenterol Hepatol, 2011, 26(5):796-801.
11. 朱林林, 王一平. Cte、Ce、Sbft、Mre對小腸克羅恩病的診斷性系統評價.解放軍醫學雜志, 2011, 36(8):848-851.
12. Dionisio PM, Gurudu SR, Leighton JA, et al. Capsule endoscopy has a significantly higher diagnostic yield in patients with suspected and established small-bowel Crohn's disease:a meta-analysis. Am J Gastroenterol, 2010, 105(6):1240-1248, 1249.
13. El-Matary W, Huynh H, Vandermeer B. Diagnostic characteristics of given video capsule endoscopy in diagnosis of celiac disease:a metaanalysis. J Laparoendosc Adv Surg Tech A, 2009, 19(6):815-820.
14. Rokkas T, Niv Y. The role of video capsule endoscopy in the diagnosis of celiac disease:a meta-analysis. Eur J Gastroenterol Hepatol, 2012, 24(3):303-308.
15. Pasha SF, Leighton JA, Das A, et al. Double-balloon enteroscopy and capsule endoscopy have comparable diagnostic yield in small-bowel disease:a meta-analysis. Clin Gastroenterol Hepatol, 2008, 6(6):671-676.
16. Chen X, Ran ZH, Tong JL. A meta-analysis of the yield of capsule endoscopy compared to double-balloon enteroscopy in patients with small bowel diseases. World J Gastroenterol, 2007, 13(32):4372-4378.
17. Cohen SA, Klevens AI. Use of capsule endoscopy in diagnosis and management of pediatric patients, based on meta-analysis. Clin Gastroenterol Hepatol, 2011, 9(6):490-496.
18. Liao Z, Gao R, Xu C, et al. Indications and detection, completion, and retention rates of small-bowel capsule endoscopy:a systematic review. Gastrointest Endosc, 2010, 71(2):280-286.
19. de Leusse A, Vahedi K, Edery J, et al. Capsule endoscopy or push enteroscopy for first-line exploration of obscure gastrointestinal bleeding? Gastroenterology, 2007, 132(3):855-862; quiz 1164-1165.
20. Leung WK, Ho SS, Suen BY, et al. Capsule endoscopy or angiography in patients with acute overt obscure gastrointestinal bleeding: A prospective randomized study with long-term follow-up. Am J Gastroenterol, 2012, 107(9):1370-1376.
21. Goldfarb NI, Phillips A, Conn M, et al. Economic and health outcomes of capsule endoscopy:Opportunities for improved management of the diagnostic process for obscure gastrointestinal bleeding. Disease Management, 2002, 5(3):123-135.
22. Somsouk M, Gralnek IM, Inadomi JM. Management of obscure occult gastrointestinal bleeding:a cost-minimization analysis. Clin Gastroenterol Hepatol, 2008, 6(6):661-670.
23. Albert JG, Nachtigall F, Wiedbrauck F, et al. Minimizing procedural cost in diagnosing small bowel bleeding:comparison of a strategy based on initial capsule endoscopy versus initial double-balloon ent-eroscopy. Eur J Gastroenterol Hepatol, 2010, 22(6):679-688.
24. Rondonotti E, Soncini M, Girelli C, et al. Cost estimation of small bowel capsule endoscopy based on "real world" data:inpatient or outpatient procedure? Dig Liver Dis, 2010, 42(11):798-802.
25. 戈之錚, 顧靜莉, 高云杰, 等.膠囊內鏡在小腸出血診斷中的效價分析.中華消化雜志, 2007, 27(6):378-381.
26. Goldfarb NI, Pizzi LT, Fuhr JP Jr, et al. Diagnosing Crohn's disease: an economic analysis comparing wireless capsule endoscopy with traditional diagnostic procedures. Dis Manag, 2004, 7(4):292-304.
27. Leighton JA, Gralnek IM, Richner RE, et al. Capsule endoscopy in suspected small bowel Crohn's disease:economic impact of disease diagnosis and treatment. World J Gastroenterol, 2009, 15(45):5685-5692.
28. Levesque BG, Cipriano LE, Chang SL, et al. Cost effectiveness of alternative imaging strategies for the diagnosis of small-bowel Crohn's disease. Clin Gastroenterol Hepatol, 2010, 8(3):261-267.
29. Nguyen Y, Murad F, Mullady D, et al. Downstream revenue stream from resource intensive small bowel endoscopies (single balloon enteroscopy, spiral balloon enteroscopy, and wireless capsule endoscopy). Gastrointestinal Endoscopy, 2010, 71(5):AB244-AB245.
30. 萬蘋, 范紅, 郭強, 等.膠囊內鏡雙氣囊內鏡單獨與聯合運用對小腸疾病診斷效力的衛生經濟學評價.中國內鏡雜志, 2011, 17(2): 151-156.
31. Gerber J, Bergwerk A, Fleischer D. A capsule endoscopy guide for the practicing clinician:technology and troubleshooting. Gastrointest Endosc, 2007, 66(6):1188-1195.
32. Sidhu R, Sanders DS, Morris AJ, et al. Guidelines on small bowel enteroscopy and capsule endoscopy in adults. Gut, 2008, 57(1):125-136.
33. 中華醫學會消化內鏡學分會小腸鏡和膠囊鏡學組.中華消化內鏡學會膠囊內鏡臨床應用規范.中華消化內鏡雜志, 2008, 25(7): 337-338.
34. Shim KN, Moon JS, Chang DK, et al. Guideline for capsule endoscopy: obscure gastrointestinal bleeding. Clin Endosc, 2013, 46(1):45-53.
35. Gossum A, Ibrahim M. Video capsule endoscopy:What is the future? Gastroenterol Clin North Am, 2010, 39:807-826.

Chinese Journal of Evidence-Based Medicine

Capsule Endoscopy in Diagnosis of Small Bowel Diseases: An Health Technology Assessment

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