1.
Meta-analysis of randomized controlled trials challenging the usefulness of purgative preparation before small-bowel video capsule endoscopy.
Gkolfakis, P, Tziatzios, G, Dimitriadis, GD, Triantafyllou, K
Endoscopy. 2018;(7):671-683
Abstract
BACKGROUND The usefulness of purgative preparation before small-bowel video capsule endoscopy is controversial. We aimed to examine the effect of purgative preparation on small-bowel video capsule endoscopy outcomes. METHODS We performed literature searches in MEDLINE and the Cochrane library for randomized controlled trials evaluating the effect of purgative preparation (polyethylene glycol, sodium phosphate, others) vs. clear-liquid diet/fasting in patients undergoing small-bowel capsule endoscopy. Meta-analysis outcomes included the examination's diagnostic yield, small-bowel mucosal visualization quality, the examination's completion rate, and gastric and small-bowel transit times. The effect size on study outcomes was calculated using a fixed- or random-effect model, as appropriate, and is shown as the risk ratio (RR) with 95 % confidence interval (CI). RESULTS We identified 12 eligible trials with 17 sets of data including 1221 subjects. Significant heterogeneity was detected with no evidence of publication bias. As compared with clear-liquid diet, purgative bowel preparation did not increase capsule endoscopy diagnostic yield (RR 1.17 [95 %CI 0.97 to 1.40]; P = 0.11). Neither the small-bowel mucosal visualization quality (RR 1.14 [95 %CI 0.96 to 1.35]; P = 0.15) nor completion rate for the examination (RR 0.99 [95 %CI 0.95 to 1.04]; P = 0.76) significantly improved after purgative preparation. Purgatives also had no effect on video capsule endoscopy gastric and small-bowel transit times. CONCLUSIONS Our analysis challenges the usefulness of purgative preparation for improving the diagnostic yield of small-bowel video capsule endoscopy and the quality of small-bowel mucosal visualization.
2.
Single versus double balloon enteroscopy for small bowel diagnostics: a systematic review and meta-analysis.
Lipka, S, Rabbanifard, R, Kumar, A, Brady, P
Journal of clinical gastroenterology. 2015;(3):177-84
Abstract
INTRODUCTION Double balloon enteroscopy (DBE) and single balloon enteroscopy (SBE) are 2 types of commonly used balloon-assisted enteroscopic techniques for "deep enteroscopy." Although there are several randomized controlled trials assessing the superiority of DBE compared with SBE, the results from individual randomized controlled trials seem conflicting. We performed a systematic review and meta-analysis to assess the efficacy of DBE compared with SBE. METHODS Primary outcomes were diagnostic and therapeutic yield. Secondary outcomes were failure rates, adverse events, complete enteroscopy, anterograde/retrograde insertion depths, and procedure times. We searched MEDLINE and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception until February 28, 2014, as well as other databases. For quality assurance purposes throughout the systematic review process, dual extraction was performed. The systematic review was performed as per the standards of Cochrane collaboration. RESULTS Four trials enrolling a total of 375 patients were included. DBE did not offer an advantage over SBE in therapeutic yield [risk ratio (RR), 1.11; 95% confidence interval (CI): 0.90, 1.37; P=0.33)] or diagnostic yield (RR=1.08; 95% CI: 0.89, 1.32; P=0.42), failure rates (RR=0.68; 95% CI: 0.23, 2.05; P=0.5), overall adverse events (RR=1.41; 95% CI: 0.32, 6.3; P=0.65), or complete enteroscopy rates (RR=1.73; 95% CI: 0.86, 3.48; P=0.12). No evidence existed for an advantage of anterograde or retrograde procedure time between these 2 modalities [mean difference (MD), 3.78; 95% CI, -30.76, 38.32; P=0.83; and MD, -0.53; 95% CI: -7.66, 6.59; P=0.88, respectively]. Neither anterograde nor retrograde insertion depths appeared to differ between the 2 studies analyzed (MD, -7.36; 95% CI: -40.36, 25.64; P=0.66 and MD, 7.86; 95% CI: -12.68, 28.40; P=0.45, respectively). CONCLUSIONS Performance of SBE and DBE appears to be similar in terms of diagnostic/therapeutic yield, insertion depths, procedure time, complete enteroscopy, failure rates, or adverse events.