How useful is capsule endoscopy for the selection of patients for double-balloon enteroscopy?

Although double-balloon enteroscopy (DBE) is useful for the diagnosis and management of patients with obscure gastrointestinal bleeding, the technique is fairly invasive, has several limitations, and can be associated with complications. It is, therefore, important to identify those patients who will benefit most from DBE, and those in whom the procedure should be avoided. In this Practice Point commentary, we discuss the findings and limitations of a retrospective study conducted by Hendel and colleagues that evaluated the utility of capsule endoscopy screening for the selection of patients with obscure gastrointestinal bleeding who would benefit from DBE. The results suggest that capsule endoscopy screening is useful to predict the diagnostic yield of DBE, guide the route of DBE, influence sedation choices, and avoid the performance of unnecessary procedures. This commentary highlights the issues to consider when interpreting and generalizing these results in clinical practice.