Double-balloon enteroscopy for retrieving retained small-bowel video capsule endoscopes: a systematic review

Background and aim: Capsule retention is the most common adverse event associated with video capsule endoscopy. The use of double-balloon enteroscopy-assisted capsule endoscope retrieval has been increasingly reported in recent years. However, evidence is limited regarding its success rate, associated factors, and subsequent clinical outcomes. Methods: A systematic review of relevant studies published before January 2019 was performed. Successful retrieval rate and associated factors, rate of endoscopic balloon dilation, and outcomes after double-balloon enteroscopy were summarized and pooled. Results: Within 154 associated original articles, 12 including 150 cases of capsule retrieval by double-balloon enteroscopy were included. The estimated pooled successful retrieval rate was 86.5% (95% confidence interval, 75.6–95.1%). Anterograde approach and capsules retained in the jejunum or trapped by malignant strictures were associated with a higher successful retrieval rate than the retrograde approach (62/83 [74.7%] vs. 10/38 [26.3%], p p p = .043). Endoscopic balloon dilation was performed in 38.8% (95% confidence interval, 22.3–56.3%) of patients with benign strictures. Two perforations (1.3%) were reported as severe adverse events after double-balloon enteroscopy. A significantly lower surgery rate was found among cases with successful video capsule removal compared with unsuccessful cases (7.2% vs. 38.5%, p = .002). Conclusions: Double-balloon enteroscopy is feasible and safe for removing retained video capsule endoscopes, and its use could decrease the need for surgery in patients with benign strictures and facilitate subsequent surgery in patients with malignant strictures.

研究背景与目的：胶囊滞留是视频胶囊内镜（video capsule endoscopy）最常见的不良事件（adverse event）。近年来，双气囊小肠镜（double-balloon enteroscopy）辅助胶囊内镜取出术的临床报道逐渐增多，但目前关于该术式的成功率、相关影响因素及后续临床结局的循证证据仍较为有限。
方法：本研究对2019年1月前发表的相关文献开展系统综述（systematic review），对双气囊小肠镜辅助胶囊取出术的总成功率、相关影响因素、内镜下球囊扩张（endoscopic balloon dilation）率及术后临床结局进行了汇总整合。
结果：在初步检索到的154篇相关原始文献中，最终纳入12篇文献，共包含150例接受双气囊小肠镜辅助胶囊取出的病例。经汇总分析，估算的总成功率为86.5%（95%置信区间（confidence interval）：75.6%~95.1%）。顺行入路、胶囊滞留于空肠或被恶性狭窄嵌顿的病例，其取出成功率显著高于逆行入路组（74.7% [62/83] vs. 26.3% [10/38]，P = 0.043）；良性狭窄患者中，内镜下球囊扩张的实施率为38.8%（95%置信区间：22.3%~56.3%）。双气囊小肠镜术后共报告2例穿孔（perforation），占比1.3%，为严重不良事件。胶囊成功取出的病例中，后续手术率显著低于未成功取出的病例（7.2% vs. 38.5%，P = 0.002）。
结论：双气囊小肠镜用于取出滞留的视频胶囊内镜具有可行性与安全性，其应用可降低良性狭窄患者的手术需求，并为恶性狭窄患者的后续手术治疗提供便利。