Diagnostic yield for video capsule endoscopy in gastrointestinal graft- versus -host disease: a systematic review and metaanalysis

Figures & data

Figure 1. Shows the PRISMA flowchart of the study selection and inclusion process. *Consider, if feasible to do so, reporting the number of records identified from each database or register searched (rather than the total number across all databases/registers). **If automation tools were used, indicate how many records were excluded by a human and how many were excluded by automation tools.

Table 1. Study & population characteristics.

Reference	Study design	Country	Number of patients	Number of VCE examinations	Time after HSCT (days)	Male/female	Age
Khodr et al. [25]	Retrospective	France	11	11	30 (27-40)	46%/54%	44 (38-49)
Blanco-Velasco et al. [26]	Retrospective	Mexico	21	21	n.a.	67%/33%	37 (25-49)
Inoki et al. [27]	Retrospective	Japan	94	148	67 (35-104)	53%/47%	55 (18-70)
Perez-Cuadrado-Robles et al. [28]	Retrospective	Spain	57	57	7 (1-27)	58%/42%	47 (32-62)
Coron et al. [29]	Prospective	France	14	14	25 (21-28)	60%/40%	47 (21-60)
Varadarajan et al. [30]	Prospective	U.S.A	11	11	77 (18-593)	36%/64%	50 (18-67)
Neumann et al. [31]	Prospective	Germany	14	14	63 (22-176)	57%/43%	49 (28-75)
Yakoub et al. [32]	Prospective	France	10	13	94 (18-189)	80%/20%	45 (32-55)

Figure 2. Forest-plot summarizing the sensitivity of VCE (a) and conventional endoscopy (b). Estimates are weighted according to the inverse variance method. TP is short for true positives and FN is short for false negatives.

Figure 3. Forest-plot summarizing the specificity of VCE (a) and conventional endoscopy (b). Estimates are weighted according to the inverse variance method. TN is short for true negatives and FP is short for false positives.

Table 2. Overview of study, population characteristics, and findings from VCE/conventional endoscopy/histopathology.

Author	Indication	Clinical usefullness of VCE	Conventional endoscopy	Histopathology	Complications of VCE
Khodr et al. [25]	Distribution of steroid-refractory GVHD	Yes. Site of GVHD identified.	GVHD findings in 5 OGD* & 8 CSPY**	Yes GVHD (n = 11)	None
Blanco-Velasco et al. [26]	Clinical suspicion of GVHD	Yes. Findings in 16 patients	Inflammatory findings in 12 OGD/CSPY	Yes, GVHD (n = 17)	5 examinations required OGD for advancement.
Inoki et al. [27]	Diarrhoea.	Yes. GVHD (n = 17), CMV enteritis (n = 14), GVHD & CMV (n = 16).	Inflammatory findings in 35/79 of OGD/CSPY	Yes, GVHD (n = 21), GVHD & CMV (n = 3), nonspecific findings (n = 8).	3 transient retention (stomach), vomiting.No retention after stomach passage.
Perez-Cuadrado-Robles et al. [28]	Clinical suspicion of GVHD	Yes. Findings in 31 patients	Inflammatory findings 33/57 of OGD, 32/48 CSPY	Yes GVHD (n = 29)	13 gastric retentions, 2 poor bowel preparation(Excluded from the final analysis)
Coron et al. [29]	GVHD surveillance	Yes. GVHD (n = 5), early mucosal lesions in asymptomatic patients.	Not available	Yes. GVHD (n = 4)	None
Varadarajan et al. [30]	GI symptoms.	Yes. GVHD (n = 9). Treatment changed in 7 patients	Inflammatory findings in 9/9 OGD/CSPY.	Yes. GVHD 9/9.No histology (n = 2)	2 gastric retentions.
Neumann et al. [31]	Distribution GVHD lesions.	Yes. GVHD (n = 7)	GVHD OGD (n = 4/14) Normal OGD in 10 pts;	Yes GVHD (n = 7), nonspecific duodenitis (n = 6).	One capsule remained in the stomach, removed by OGD
Yakoub et al. [32]	Suspicion of GVHD (n = 9) Diarrhoea during skin and liver GVHD (n = 3), Control (n = 1)	Yes. Treatment changed in 8 patients.	GVHD OGD (2/13), 1/2 CSPY colitis.	Yes GVHD in 4/9 patients; nonspecific changes 5/9.	None

* OGD is short for oesophagogastro duodenoscopy.

** CSPY is short for colonoscopy.

Figure 4. Quality assessment of diagnostic accuracy studies-2.

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