Capsule Endoscopy Complements Magnetic Resonance Enterography and Endoscopy in Evaluating Small Bowel Crohn’s Disease

Abstract

Aims Wireless capsule endoscopy (WCE) and magnetic resonance enterography (MRE) are increasingly utilized to evaluate the small bowel (SB) in Crohn’s disease (CD). The primary aims were to compare the ability of WCE and MRE to detect SB inflammation in children with newly diagnosed CD, and in the terminal ileum (TI) to compare them to ileo-colonoscopy. Secondary aims were to compare diagnostic accuracy of WCE and MRE and changes in Paris classification after each study. Methods Patients (10 to 17 years of age) requiring ileo-colonoscopy for suspected CD were invited to participate. Only patients with endoscopic/histologic evidence of CD underwent MRE and WCE. SB inflammation and extent were documented and comparative analyses performed. Results Of 38 initially recruited subjects, 20 completed the study. WCE and MRE were similarly sensitive in identifying active TI inflammation (16 [80%] versus 12 [60%]) and any SB inflammation (17 [85%] versus 16 [80%]). However, WCE detected more extensive SB disease than MRE with active inflammation throughout the SB in 15 [75%] versus 1 [5%] patient (P < 0.001). Moreover, WCE was more likely to detect proximal SB disease (jejunum and ileum) compared to MRE (85% versus 50%, P = 0.04). Overall, the Paris classification changed in 65% and 85% of patients following MRE and WCE, respectively. Conclusions WCE is as sensitive as MRE for identifying active TI inflammation, but appears more sensitive in identifying more proximal SB inflammation. In the absence of concern regarding stricturing or extra-luminal disease WCE can be considered for the evaluation of suspected SB CD.

The Role of Capsule Endoscopy in Crohn's Disease: A Review

“…[26]. The authors had widely the same results as the studies discussed earlier, with CE being more sensitive than MRE (80% vs. 60%, respectively) (Table 1) [26]. CE was also shown to detect more proximal and extensive small bowel disease.…”

“…This is against the current guidelines that generally assume a gold standard of histopathology from ileocolonoscopy (IC) and/or surgery for diagnosis [16]. [26]. The authors had widely the same results as the studies discussed earlier, with CE being more sensitive than MRE (80% vs. 60%, respectively) (Table 1) [26].…”

“…Forty-seven patients with established or suspected CD were assessed, with 36 (76.6%) found to have small bowel lesions and less than half (21, i.e., 44.7%) detected by MRE (Table 1 ) [ 25 ]. Prichard et al sought to investigate this prospectively in 38 established CD patients, 20 of whom completed the study [ 26 ]. The authors had widely the same results as the studies discussed earlier, with CE being more sensitive than MRE (80% vs. 60%, respectively) (Table 1 ) [ 26 ].…”

“…Prichard et al sought to investigate this prospectively in 38 established CD patients, 20 of whom completed the study [ 26 ]. The authors had widely the same results as the studies discussed earlier, with CE being more sensitive than MRE (80% vs. 60%, respectively) (Table 1 ) [ 26 ]. CE was also shown to detect more proximal and extensive small bowel disease.…”

Characteristics of small bowel lesions and disease evaluation in Crohn’s disease by Capsule endoscopy

“…Although double-balloon enteroscopy (DBE) can scan the entire small intestinal, there still remains some problem such as risk of anesthesia and severe accident. As a noninvasive tool, capsule endoscopy (CE) has been con rmed with good sensitivity to detect lesions of small-bowel CD [5,6] , which has a higher priority than others for clinically suspected CD without obstruction [7] . Even, recent study mentioned some small bowel lesions may only be detected by CE [8] .…”