Diagnostic Yield of Spiral Enteroscopy When Performed for the Evaluation of Abnormal Capsule Endoscopy Findings

Background: Spiral enteroscopy (SE) has emerged as a new alternative for deep intubation of the small intestine. SE is most often used to evaluate abnormal findings on capsule endoscopy (CE). Objective: Investigate the ability of SE to reproduce abnormal findings detected on preceding CE. Design: Prospective study. Setting: Two academic tertiary care centers. Patients: Consecutive patients undergoing SE to investigate a clinically significant finding on CE. Main Outcome Measurement: Ability of SE to identify findings on CE. Results: Total of 56 anterograde SE procedures were performed. CE findings included arteriovenous malformations (AVMs) (n = 26), masses (n = 8), ulcers (n = 4), polyps (n = 4), abnormal mucosa (n = 6), fresh blood (n = 6), and stricture (n = 1). Majority of the patients had CE findings located in the jejunum (41 of 56 or 73.2%). Mean depth of enteroscope insertion was 224.6 +/- 68.7 cm. SE detected relevant small bowel pathology in 32 of 56 (57.1%) patients. Findings on CE were reproduced in 30 of 56 (53.6%) cases. Reproducibility was independent of patient body mass index (P = 0.38), CE indication (P = 0.24), CE lesion location (P = 0.29), days between CE and SE (P = 0.30), and depth of insertion (P = 0.81). Type of CE findings (particularly AVMs) significantly affected SE reproducibility (P = 0.015). SE procedure time was inversely related to SE reproducibility (odds ratio = 0.94, 95% confidence interval = 0.88-0.99, P = 0.02). Limitations: Small sample size and potential for false-positive CE study. Conclusions: SE seems to be moderately effective (57.1%) in terms of its ability to locate pathology within the small intestine. The type of small bowel pathology targeted by SE may affect its clinical utility. AVMs observed on CE can be seen at the time of SE in the majority of cases (60%).