Comparison of Capsule Endoscopy and Magnetic Resonance Enterography for the Assessment of Small Bowel Lesions in Crohn’s Disease

González-Suárez, Begoña; Rodríguez, Sónia; Ricart, Elena; Ordás, Íngrid; Rimola, Jordi; Díaz-González, Álvaro; Romero, Cristina; Miguel, Cristina Rodríguez de; Jáuregui, Arantxa; Araujo, Isis K.; Ramírez, Ana Argudo; Gállego, Marta; Fernández‐Esparrach, Glòria; Ginés, Àngels; Sendino, Oriol; Llach, Josep; Panés, Julián

doi:10.1093/ibd/izx107

Cited by 58 publications

(60 citation statements)

References 28 publications

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“…Therefore, radiographic tests, such as CTE and MRE, are frequently substituted as rst-line tests to evaluate the small bowel in this context. Notably, the yield of CTE and MRE are reported to be considerably inferior to VCE for diagnosing small bowel lesions, albeit not all lesions identi ed on VCE might be considered clinically signi cant in these studies [16,17,18].…”

Section: Introductionmentioning

confidence: 76%

Small Bowel Radiographic Imaging is Not Useful for Isolated Iron-Deficiency Anemia

Hae¹,

Murthy²

2019

Preprint

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Background Iron deficiency anemia in the absence of overt bleeding can result from chronic occult blood loss from the gastrointestinal tract. When esophagogastroduodenoscopy (EGD) and colonoscopy fail to demonstrate clinically significant lesions (CSLs), practitioners often consider small bowel investigations, such as CT enterography and video capsule endoscopy. Although most society guidelines recommend further investigations to evaluate the small bowel, few studies have evaluated the utility of small bowel radiographic imaging in this setting.Methods This is a retrospective cross-sectional study investigating the rates and types of CSLs identified during EGD, colonoscopy and small bowel imaging among individuals over age 50 who were referred for new-onset iron deficiency anemia without overt bleeding. Data was collected on 334 consecutive patients who underwent colonoscopy with or without EGD to evaluate new-onset iron deficiency anemia at The Ottawa Hospital from January 1, 2010 to March 30, 2012. We evaluated the frequency of CSLs among all patients and those who further underwent small bowel radiographic imaging.Results Of the 332 individuals who underwent colonoscopy, 42 (12.7%) were found to have a CSL, with 37 of these being malignancy or high-grade adenomas. Of the 258 individuals who also underwent EGD, 49 (19.0%) had CSLs, including 11 vascular ectasias, 15 peptic ulcer disease, 8 celiac disease, 8 severe erosive esophagitis, and 9 esophageal varices. Of 243 patients who did not have any CSLs identified on colonoscopy +/- EGD, 75 underwent subsequent small bowel imaging, and 9 patients underwent small bowel imaging despite having a CSL found on endoscopy. A total of 84 patients underwent subsequent small bowel imaging (68 CT enterography, 13 small bowel follow-through, one MR enterography, one CT enteroclysis, and one push enteroscopy). In these 84 patients, only one relevant CSL was found (inflammatory bowel disease).Conclusions Upper and lower endoscopy are valuable tools for diagnosing gastrointestinal tract lesions in individuals over the age of 50 with newly diagnosed iron deficiency anemia in the absence of overt bleeding. CT enterography and small bowel follow-through have limited utility in this setting.

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Section: Introductionmentioning

confidence: 76%

Small Bowel Radiographic Imaging is Not Useful for Isolated Iron-Deficiency Anemia

Hae¹,

Murthy²

2019

Preprint

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“…Patients with SB wall thickening (>3 mm), hyperenhancement, mural edema, comb sign (a sign of engorged vasa recta), enlarged lymph nodes, or the presence of ulcers were considered having signs of SB CD by MRE criteria [15,16]. Strictures were defined as a change in a bowel caliber with dilatation of the proximal segment above 2.5 cm [1,17].…”

Section: Magnetic Resonancementioning

confidence: 99%

Magnetic Resonance Enterography and Capsule Endoscopy in Patients Undergoing Patency Capsule for the Evaluation of Small Bowel Crohn’s Disease: A Korean Clinical Experience

Lee

Lim

Jung

et al. 2020

Gastroenterology Research and Practice

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Objective. Studies comparing magnetic resonance enterography (MRE) and capsule endoscopy (CE) for the assessment of small bowel (SB) Crohn’s disease (CD) are scarce in Korea. In addition, there is no Korean experience of patency capsule (PC) examination prior to CE. The primary aim of this study was to compare diagnostic yields of MRE and CE for the assessment of SB CD. Secondary objectives were to compare the detection rate of proximal SB lesions by each modality in the Montreal classification and evaluate the safety and feasibility of PC in Korean CD patients. Methods. MRE was performed as the first examination to assess SB CD. PC examination and CE were then performed. Diagnostic yields of active SB disease by MRE and CE were then analyzed. Results. Disintegration of the patency capsule was shown in 5 patients out of 26 patients, who did not undergo CE. These 5 patients were accounted as negative CE findings. Overall, MRE and CE detected 80.8% and 65.4% of active SB lesions of CD in 26 patients, respectively (P=0.212). MRE and CE detected 0% (0/26) and 19.2% (5/26) (P=0.051) of jejunal lesions, 30.8% (8/26) and 42.3% (11/26) (P=0.388) of proximal ileal lesions, and 80.8% (21/26) and 53.8% (14/26) (P=0.039) of terminal ileal lesions, respectively. According to the Montreal classification, MRE and CE independently detected proximal disease (L4) in 30.8% (8/26) and 53.8% (14/26) (P=0.092), respectively. Conclusions. The diagnostic yields of MRE and CE for the assessment of SB CD including proximal SB lesions were similar. MRE is a more objective tool for detecting clinically relevant stricture than PC although PC examination could be performed safely before CE to prove the patency of SB. This trial is registered with KCT0004305.

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“…The discrepancy between imaging and CE has been attributed to the low sensitivity of MRE and CTE for luminal inflammation not involving deeper intestinal wall layers. 4,5 However, such CE findings have often been dismissed as clinically irrelevant. In our study we demonstrated that CE findings changed the patient management (ie, initiation or escalation of therapy) in up to 50% of cases.…”

Section: Unexplained Symptoms and Hidden Inflammation In Patients Witmentioning

confidence: 99%

“…In view of these considerations, surveillance of the pancreas remains a potentially dangerous form of screening that should be limited to expert centers and only performed in a research setting. 4 In addition, the program should only be offered to individuals with a substantially increased risk of pancreatic cancer. This was shown in a simulation study by Pandharipande et al, 5 who found that screening of low-risk individuals was associated with a reduced life expectancy, an outcome attributed to the increased discovery of insignificant lesions and subsequent unnecessary surgical intervention.…”

Section: Screening Of Individuals At High Risk For Pancreatic Cancermentioning

confidence: 99%

Unexplained Symptoms and Hidden Inflammation in Patients With Crohn’s Disease

Sorrentino

Nguyen

2019

Clinical Gastroenterology and Hepatology

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Comparison of Capsule Endoscopy and Magnetic Resonance Enterography for the Assessment of Small Bowel Lesions in Crohn’s Disease

Abstract: In our cohort CE was significantly superior to MRE for detecting SB lesions, mainly superficial and proximal lesions. CE is useful for a appropriate patients' classification according to Montreal classification.

Cited by 58 publications

References 28 publications

Small Bowel Radiographic Imaging is Not Useful for Isolated Iron-Deficiency Anemia

Small Bowel Radiographic Imaging is Not Useful for Isolated Iron-Deficiency Anemia

Magnetic Resonance Enterography and Capsule Endoscopy in Patients Undergoing Patency Capsule for the Evaluation of Small Bowel Crohn’s Disease: A Korean Clinical Experience

Unexplained Symptoms and Hidden Inflammation in Patients With Crohn’s Disease

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