A randomized trial comparing wireless capsule endoscopy with push enteroscopy for the detection of small-bowel lesions

Background & Aims: Wireless capsule endoscopy is a new, painless method of imaging the entire small bowel. It has not been compared with push enterosc opy. We compared the sensitivity, specificity, and safety of capsule and pu sh enteroscopy in detecting small-bowel lesions. Methods: Nine to 13 radiop aque, colored beads (3- 6 mm diameter) were sewn in random order inside 9 c anine small bowels, half within the first meter, and confirmed on x-ray. Af ter recovery, the number, order, and color of beads were assessed in 23 cap sule enteroscopies and 9 push enteroscopies in a random order. The surgeons , push enteroscopists, capsule video interpreters, and pathologist were bli nded to the others' findings. Results: The capsules identified move beads t han push enteroscopy (median, 6 [range, 2-9] vs. 3 [range, 2-6 beads]; P < 0.001). The sensitivity of the capsule was 64% compared with 37% for push e nteroscopy. The specificity was 92% for capsule enteroscopy and 97% for pus h enteroscopy. The capsules identified significantly more beads beyond the reach of the push enteroscope (median, 4 [range, 2-7] vs. 0; P < 0.0001). H air, ingested plastic, ulceration, submucosal swelling, and worms were clea rly identified by the capsule. The capsules passed safely through the anima ls with no significant histologic findings. Conclusions: Wireless capsule e ndoscopy detected move abnormalities in the small bowel than push enterosco py.