[Diagnostic Agreement Between Capsule Endoscopy and Double-Balloon Enteroscopy in Mid-Gut Gastrointestinal Bleeding at a Referral Hospital in Peru].

INTRODUCTION

The diagnostic approach to mid-gut gastrointestinal bleeding requires several examinations, primarily video capsule endoscopy followed by double-balloon enteroscopy) at tertiary care centers.

OBJECTIVE

To evaluate the level of diagnostic agreement between video capsule endoscopy and double-balloon enteroscopy in patients treated with mid-gut gastrointestinal bleeding at a referral hospital in Lima, Peru, during the 2020-2025 period.

METHODS

This was an observational, retrospective, and comparative study. Diagnostic agreement between the two procedures was calculated using the Kappa coefficient. Statistical analysis was performed using IBM SPSS Statistics v.20.0 and R software version 4.1.2, with a significant p-value < 0.05.

RESULTS

In fifty-one patients with mid-gut gastrointestinal bleeding (28 women; median age: 65 years [IQR: 55-71]), video capsule endoscopy and subsequent double-balloon enteroscopy (39 antegrade and 12 retrograde) were performed. Most patients (34/51; 66.7%) presented with overt mid-gut gastrointestinal bleeding, while the rest had occult bleeding, with a mean hemoglobin level of 7.3 ± 2.24 g/dL. The median time interval between the two procedures was 13 days (IQR 5-29). In 10 (19.6%) patients where video capsule endoscopy showed positive findings, no lesions were identified during double-balloon enteroscopy , whereas in one case (2%) with a negative video capsule endoscopy , double-balloon enteroscopy was positive. Overall diagnostic agreement was low (κ = 0.37; [95% CI: 0.10-0.64]; p = 0.002). Moderate agreement was observed regarding lesion type (κ = 0.58; [95% CI: 0.42-0.74]; p < 0.001) and lesion location (κ = 0.50; [95% CI: 0.31-0.69]; p < 0.001), with moderate agreement for vascular (κ = 0.60) and tumoral (κ = 0.60) lesions.

CONCLUSION

Video capsule endoscopy and double-balloon enteroscopy showed low overall diagnostic agreement in patients with mid-gut gastrointestinal bleeding, and moderate agreement regarding the type and location of the lesion.