Is There a Role for Sonde Enteroscopy in Patients with Obscure Gastrointestinal Bleeding? A Comparison with Capsule Endoscopy

BACKGROUND In the 1980's and 1990's combined Push and Sonde Enteroscopy was the primary endoscopic tool used to evaluate the small intestine in patients with obscure gastrointestinal bleeding (OGIB). It was available in only a few centers due to the technical difficulties associated with its use. The introduction of wireless capsule endoscopy in 2001 revolutionalized small bowel endoscopic imaging making Sonde enteroscopy a rarely used procedure despite the lack of studies comparing the efficacy of the two modalities. The aim of this study was to restrospectively compare the findings of Sonde enteroscopy with capsule endoscopy in patients with OGIB. METHODS Design: One hundred patients who underwent Sonde enteroscopy and 101 patients who underwent capsule endoscopy were retrospectively studied. Setting: All patients had their procedures completed by physicians within the same gastroenterology practice. Patients: All patients who underwent either Sonde enteroscopy or capsule endoscopy were enrolled. Interventions: None. Main outcome measurements: Outcome was defined as the number of patients in which a distinct bleeding site could be identified. RESULTS A total of 100 patients underwent Push and Sonde enteroscopy and a potential bleeding site was identified in 55 (55%) patients. A total of 101 patients underwent capsule endoscopy and a potential bleeding site was identified in 60 (59%) patients. A one-tailed P value showed no statistically significant difference in the diagnostic yield between the procedures. CONCLUSIONS Capsule endoscopy is at least as efficacious as Push/Sonde enteroscopy in evaluating patients with OGIB. We can comfortably retire Sonde enteroscopy as a diagnostic tool.