Diagnosis of small bowel Crohn's disease: a prospective comparison of capsule endoscopy with magnetic resonance imaging and fluoroscopic enteroclysis

Albert, Jörg G.; Martiny, Frederik; Krummenerl, Annette; Stock, Karsten; Leßke, J.; Göbel, Christa-Maria; Lotterer, E.; Nietsch, Hubert; Behrmann, Curd; Fleig, Wolfgang E.

doi:10.1136/gut.2005.069427

Cited by 273 publications

(160 citation statements)

References 29 publications

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“…The only limitations of capsule endoscopy include difficulty in localizing mucosal lesions anatomically and its restricted use in patients with strictures or motor dysfunction. By choosing MRI as a complementary means in diagnosing small bowel Crohn's disease, transmural and extra-luminal lesions, as well as strictures, may be ruled in and ruled out (45). …”

Section: Resultsmentioning

confidence: 99%

“…Thus a comparison of diagnostic yields between VCE and MR-enteroclysis in 52 consecutive patients with small bowel Crohn's disease was impaired due to bowel strictures in 14, who had to be excluded from capsule enteroscopy. Of the remaining 27 patients, VCE and MRI detected small bowel Crohn's disease in 93% and 78% respectively (45).…”

Section: Further Aspects Of Vce and Radiologymentioning

confidence: 97%

“…The corresponding ability of VCE to delineate transmural complications is limited, as VCE cannot disclose changes in the mesenteric fibrofatty tissue, hyperaemia and involvement of the lymphatic systems. It seems therefore justified to conclude that VCE, enteroclysis with MRI and CT are complementary tools for a global understanding of small bowel Crohn's disease (42,43) the first capable of detecting mucosal lesions (44), the latter two transmural and extra-intestinal manifestations (45,46). CTenteroclysis has been reported to have less favourable results (47).…”

Section: Small Bowel Bleedingmentioning

confidence: 99%

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Capsule enteroscopy and radiology of the small intestine

Fork

Aabakken

2007

Eur Radiol

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Capsule Enteroscopy and Radiology of the Small Intestine 2 ABSTRACT In a very few years, the video capsule for small bowel enteroscopy has gained widespread clinical acceptance. It is readily ingested, disposable, and allows for a complete, low-invasive endoscopic examination of the entire mucosa of the small bowel. It is a patient-friendly method and a first line procedure in the difficult evaluation of obscure gastrointestinal bleeding. It has the highest proven figure of diagnostic sensitivity for detecting lesions of the mucosa, irrespective of aetiology. The limitations of capsule endoscopy include difficulty in localizing mucosal lesions anatomically and its restricted use in patients with dysphagia, strictures or motor dysfunction. Strictures, transmural and extra-mural lesions in patients with small bowel Crohn's disease are evaluated by MRI-enterography and CT-enterography.Capsule Enteroscopy and Radiology of the Small Intestine 3 Imaging of the small bowel was, until recently, the responsibility of the radiologist, who, in dedicated centres, offered the patient not just a small-bowel follow-through with single exposures over time, but a dedicated, real time, fluoroscopic examination of a well distended small bowel, displayed in double-contrast and documented on spot films (1). This enteroclysis technique, well accepted by gastroenterologists, significantly improved both the detection of mucosal disease and the mapping of involved bowel segments. However, the duration of the examination, discomfort related to nasojejunal intubation and infusion of large volumes of contrast and distension materials, be it methyl cellulose or air (2), reduced general acceptance and dissemination of this method (3). VCE has evolved to be the first line procedure in many hospitals (7-13), keeping small bowel radiology as method of choice for patients who cannot take the capsule (13). In order to understand the diagnostic algorithm of modern small bowel examination we will discuss the video capsule technique, its indications and contraindications, advantages and disadvantages, types of true and false lesions and comparative studies of VCE and radiological methods of investigation of the small intestine. The video capsuleVCE was primarily developed for examination of small bowel mucosa (14,15). Rapid technical refinement has since resulted in a dedicated capsule for the oesophagus, and recently capsules for the study of both stomach and colon (16).The capsule measures 11 by 27mm and includes a light source and a camera inside a clear, transparent dome, batteries and a radio-transmitter (Figure 1). Whilst ushered forward by peristalsis the capsule transmits images continuously at two frames per second for around eight hours, a total of more than 60.000 images. The image has a 140° field of view, a focus depth of 1-30 mm, and an 8:1 magnification (17). An array of eight external detectors, applied to the abdominal wall, receives the images for storage in a solid state data recorder. Capsule Enteroscopy and Radiology of the Smal...

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Section: Resultsmentioning

confidence: 99%

Section: Further Aspects Of Vce and Radiologymentioning

confidence: 97%

Section: Small Bowel Bleedingmentioning

confidence: 99%

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Capsule enteroscopy and radiology of the small intestine

Fork

Aabakken

2007

Eur Radiol

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“…Capsule endoscopy provides meaningful information on the inflammatory burden in the small bowel mucosa, similarly to the role of conventional ileocolonoscopy for the colon and the terminal ileum. Bowel stenosis should be ruled [81] 35 77% 20% 47% < 0.05 Hara et al [82] 17 71% 53% 18% NA Voderholzer et al [83] 41 61% 49% (CT enteroclysis) 12% < 0.04 Solem et al [84] 40 83% 83% 0 NS MRE Albert et al [85] 27 93% 78% 15% NS Crook et al [22] 19 93% 71% 18% NS Jensen et al [20] 93 100% 86% 14% NS Ileocolonoscopy Hara et al [82] 17 71% 65% 6% NS Solem et al [84] 40 83% 74% 9% NS Leighton et al [86] 80 be demonstrated in 73%-93% of the patients within 1 year of ileocolonic resection [29,30] . SB lesions associated with postoperative recurrence are frequently quantified using the Rutgeerts score [29] .…”

Section: Vce In Established CDmentioning

confidence: 99%

Role of capsule endoscopy in inflammatory bowel disease

Leighton

Legnani

Seidman

2007

Inflammatory Bowel Diseases

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Videocapsule endoscopy (VCE) has revolutionized our ability to visualize the small bowel mucosa. This modality is a valuable tool for the diagnosis of obscure small bowel Crohn's disease (CD), and can also be used for monitoring of disease activity in patients with established small-bowel CD, detection of complications such as obscure bleeding and neoplasms, evaluation of response to anti-inflammatory treatment and postoperative recurrence following small bowel resection. VCE could also be an important tool in the management of patients with unclassified inflammatory bowel disease, potentially resulting in reclassification of these patients as having CD. Reports on postoperative monitoring and evaluation of patients with ileal pouch-anal anastomosis who have developed pouchitis have recenty been published. Monitoring of colonic inflammatory activity in patients with ulcerative colitis using the recently developed colonic capsule has also been reported. Capsule endoscopy is associated with an excellent safety profile. Although retention risk is increased in patients with small bowel CD, this risk can be significanty decreased by a routine utilization of a dissolvable patency capsule preceding the ingestion of the diagnostic capsule. This paper contains an overview of the current and future WJG 20 th Anniversary Special Issues (3): Inflammatory bowel disease TOPIC HIGHLIGHTclinical applications of capsule endoscopy in inflammatory bowel disease.

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“…Chronic inflammatory disease, and in particular, CD, represents the most common application of MRI of small bowel [1][2][3][4][5]8,9,15,[28][29][30][31][32][33][34][35]38] .…”

Section: Inflammatory Bowel Disease (Cd) (Figures 1-4)mentioning

confidence: 99%

Updating magnetic resonance imaging of small bowel: Imaging protocols and clinical indications

Zhu¹,

Xu²,

Gong³

et al. 2008

WJG

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High soft tissue contrast resolution, acquisition of multi-planar images and the possibility to obtain functional information make magnetic resonance an interesting imaging technique to evaluate the small bowel disease. The absence of ionizing radiation is an important feature of magnetic resonance imaging (MRI) examinations because inflammatory diseases such as Crohn's disease (CD) are studied most frequently, which are prevalent among children and young adults. MRI, using modern equipment and a rigorous technical approach, can offer detailed morphologic information and functional data on the small bowel. This article discusses the MRI protocols for small bowel and the MR imaging findings of small bowel diseases, such as CD and small bowel neoplasms. There are two main approaches for MRI of the small bowel: (1) study following oral administration of contrast material; and (2) study with distension of lumen obtained with contrast material that is introduced through a naso-jejunal tube (MR enteroclysis). Oral contrast agents for small bowel MRIOral contrast agents can be classified into positive, negative and biphasic categories according to their action on the signal intensity of bowel lumen.A positive agent is a paramagnetic substance that produces a high signal intensity on T1-weighted sequences. It reduces T1 relaxation time without, or only minimally, influencing T2 relaxation time. Because of the water content of the contrast solution, it also results in high signal intensity on T2-weighted images. Positive contrast agents include paramagnetic substances, such as gadolinium chelates, ferrous and manganic ions and manganese ions [12][13][14][15][16] . The use of positive oral contrast agents has been abandoned almost completely because a hyperintense lumen does not enable a clear differentiation with inflammatory parietal enhancement.A negative agent is a substance that produces a low signal intensity on T1-and T2-weighted sequences. These substances induce local inhomogeneity in the magnetic field that affects T1 and T2 relaxation time. T2 effects predominate and are caused by spin dephasing with a consequent loss of signal intensity. Negative contrast agents include perfluorooctyl bromide [17] , iron oxides [15,18] , and oral magnetic particles [14,15] . Barium sulfate, if used at high concentrations, can be considered a negative contrast agent [19] . Negative contrast agents are more favorable if hyperintense signal of the bowel wall and the surrounding fat tissue signs of acute inflammation have to be detected on T2-weighted sequences [15] . However, magnetic susceptibility on gradient echo sequences may alter image quality on breath-held T1-weighted images.The term "biphasic" recently was introduced to define those substances that show different signal intensities depending on different sequences [20] . The first group (hyperintense signal on T1-weighted images and hypointense signal on T2-weighted images) included manganese and substances that contain manganese, and gadolinium chelates, w...

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Diagnosis of small bowel Crohn's disease: a prospective comparison of capsule endoscopy with magnetic resonance imaging and fluoroscopic enteroclysis

Cited by 273 publications

References 29 publications

Capsule enteroscopy and radiology of the small intestine

Capsule enteroscopy and radiology of the small intestine

Role of capsule endoscopy in inflammatory bowel disease

Updating magnetic resonance imaging of small bowel: Imaging protocols and clinical indications

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