Small bowel disorders, including obscure gastrointestinal bleeding (OGIB), Crohn's disease, and tumors, requireaccurate diagnostic approaches for effective treatment. Video capsule endoscopy (VCE) and simple balloon enteroscopy (SBE) arewidely used, but each modality has limitations, particularly regarding therapeutic intervention and diagnostic yield.

A comprehensive search of four databases (PubMed, Embase, Cochrane Library, and Scopus) revealed over 600 citations for applying capsule endoscopy and balloon enteroscopy for small intestine diagnosis following wall thickening. Following a rigorous assessment of these citations based on a predetermined eligibility criterion, seven moderate-to-high-quality retrospective studies were conducted evaluating the diagnostic performance of VCE and SBE in patients with small bowel disorders. The studies were assessed using QUADAS-2 to evaluate the risk of bias and overall methodological quality.

The analysis of seven moderate-to-high-quality retrospective studies revealed comparable overall detection rates for small bowel lesions between Video Capsule Endoscopy (VCE) and Simple Balloon Enteroscopy (SBE). VCE demonstrated superior performance in detecting vascular lesions, with one study reporting 39 cases identified by VCE compared to 30 cases by SBE (p <

0.05). Conversely, SBE exhibited higher efficacy in detecting ulcerative lesions, with a statistically significant difference of 28 cases versus 10 cases identified by VCE (p < 0.01). The overall diagnostic yield varied across studies, with VCE showing a range of 32-83% for small bowel bleeding, while SBE demonstrated a higher overall detection rate of 69.7% compared to 57.6% for VCE in one study (p < 0.05). Notably, SBE showed superior performance in diagnosing Crohn's disease, with a detection rate of 35% compared to 11.3% for VCE (p < 0.001). The diagnostic concordance between VCE and SBE was influenced by lesion type. Strong agreement was observed for inflammatory lesions (κ = 0.82, 95% CI: 0.75-0.89), while moderate agreement was noted for tumors (κ = 0.61, 95% CI:0.52-0.70) and angiectasias (κ = 0.58, 95% CI: 0.49-0.67). In terms of clinical utility, SBE demonstrated significant advantages in therapeutic intervention, particularly in cases of overt bleeding. One study reported immediate hemostasis achieved in 92% of cases where active bleeding was identified during SBE (95% CI: 86-98%). Patient tolerability was generally higher for VCE, with a completion rate of 95% (95% CI: 92-98%) compared to 85% for SBE (95% CI: 80-90%). However, the capsule retention rate for VCE was reported at 1.4% (95% CI: 0.8-2.0%), necessitating subsequent intervention.

VCE and SBE are complementary techniques in evaluating small bowel disorders. While VCE remains the initial test of choice for stable patients with OGIB, SBE should be considered for cases requiring therapeutic intervention. The findings suggest that combining both modalities enhances diagnostic accuracy and patient management. Further research should focus on improving CE interpretation and the ability of SBE to provide comprehensive small bowel exploration.