Inflammatory disorders of the small bowel represent a heterogeneous spectrum of diseases, in which endoscopic lesions show considerable variability in terms of location, extent, and morphological features. The aim of the study was to investigate the correlation between capsule endoscopy (SBCE) and double balloon enteroscopy (DBE) in the evaluation of inflammatory lesions of the small bowel.

This is a retrospective, single-center observational study including all SBCE and DBE performed at an Italian tertiary referral center between January 2018 and June 2025. The selected study period was determined by the availability of complete endoscopic data within the hospital’s Picture Archiving and Communication System (PACS) wich ensured a comprehensive and standardized data source for retrospective analysis. Patients with at least one inflammatory small-bowel mucosal lesion on SBCE or DBE were included. These inflammatory findings were defined according to the Delphi consensus on Crohn’s disease capsule endoscopy lesions and the I-CARE international consensus on atrophic patterns. Patients with a conclusive diagnosis of neoplasia were excluded. SBCE PillCam SB3 or PillCam Crohn’s were used according to clinical indication. Fujifilm DBE was performed antegrade or retrograde based on presumed lesion location. The diagnostic performance of SBCE for inflammatory lesions was assessed using DBE as the reference standard; sensitivity, specificity, and Cohen’s kappa were calculated.

295 endoscopic procedures were analyzed, 195 SBCE (145 PillCam SB3, 50 PillCam Crohn) and 100 DBE (73 anterograde, 27 retrograde). Among these, 102 paired enteroscopies were performed (51 SBCE and 51 DBE) within six months thus allowing comparison of the two techniques. SBCE demonstrated an overall high specificity, greater than 80%, for all inflammatory lesions. Sensitivity was more variable: high (>80%) for aphthoid lesions and villous atrophy, good (70%) for deep ulceration, stenosis and scalloping, and lower for the other lesions. Agreement was excellent (κ ≥ 0.6) for stenosis, edema and villous atrophy; good (κ 0.4–0.6) for deep ulceration, hyperemia, mucosal denudation and mosaicism; and only fair to weak for aphthous lesions and superficial ulcerations. Fold reduction and granular mucosa showed very low κ values, probably due to the small number of cases. Data are reported in the Table.

 SBCE performance compared to DBE.

SBCE demonstrated an overall good performance in the evaluation of inflammatory lesions of the small bowel. It showed good agreement with DBE, the reference standard for enteroscopy, in detecting most inflammatory lesions, including both ulcerative–stenosing and atrophic patterns. Further multi-center studies with larger sample sizes and external validation in different study populations are needed to confirm these findings.