Effectiveness of Capsule Endoscopy Compared with Other Diagnostic Modalities in Patients with Small Bowel Crohn’s Disease: A Meta-Analysis

Choi, Miyoung; Lim, Sungwon; Choi, Myung Gyu; Shim, Ki Nam; Lee, Seon Heui

doi:10.5009/gnl16015

Cited by 40 publications

(37 citation statements)

References 40 publications

(81 reference statements)

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“…There have been several systematic reviews and meta-analyses reporting the accuracy of MRE and US for diagnosing and staging CD. 12,[15][16][17][18][19][20][21][22][23][24][25][26] Many have considered MRE or US in isolation, 15,[17][18][19][20]22,23 whereas others have attempted to compare the two modalities (along with others, such as CT). 12,21,25,26 Some have primarily focused on assessment of disease activity, 17,22,26 with most assessing diagnostic accuracy.…”

Section: Existing Literature On the Diagnostic Accuracy Of Magnetic Rmentioning

confidence: 99%

Magnetic resonance enterography compared with ultrasonography in newly diagnosed and relapsing Crohn’s disease patients: the METRIC diagnostic accuracy study

Taylor

Mallett

Bhatnagar

et al. 2019

Health Technol Assess

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Background Magnetic resonance enterography and enteric ultrasonography are used to image Crohn’s disease patients. Their diagnostic accuracy for presence, extent and activity of enteric Crohn’s disease was compared. Objective To compare diagnostic accuracy, observer variability, acceptability, diagnostic impact and cost-effectiveness of magnetic resonance enterography and ultrasonography in newly diagnosed or relapsing Crohn’s disease. Design Prospective multicentre cohort study. Setting Eight NHS hospitals. Participants Consecutive participants aged ≥ 16 years, newly diagnosed with Crohn’s disease or with established Crohn’s disease and suspected relapse. Interventions Magnetic resonance enterography and ultrasonography. Main outcome measures The primary outcome was per-participant sensitivity difference between magnetic resonance enterography and ultrasonography for small bowel Crohn’s disease extent. Secondary outcomes included sensitivity and specificity for small bowel Crohn’s disease and colonic Crohn’s disease extent, and sensitivity and specificity for small bowel Crohn’s disease and colonic Crohn’s disease presence; identification of active disease; interobserver variation; participant acceptability; diagnostic impact; and cost-effectiveness. Results Out of the 518 participants assessed, 335 entered the trial, with 51 excluded, giving a final cohort of 284 (133 and 151 in new diagnosis and suspected relapse cohorts, respectively). Across the whole cohort, for small bowel Crohn’s disease extent, magnetic resonance enterography sensitivity [80%, 95% confidence interval (CI) 72% to 86%] was significantly greater than ultrasonography sensitivity (70%, 95% CI 62% to 78%), with a 10% difference (95% CI 1% to 18%; p = 0.027). For small bowel Crohn’s disease extent, magnetic resonance enterography specificity (95%, 95% CI 85% to 98%) was significantly greater than ultrasonography specificity (81%, 95% CI 64% to 91%), with a 14% difference (95% CI 1% to 27%). For small bowel Crohn’s disease presence, magnetic resonance enterography sensitivity (97%, 95% CI 91% to 99%) was significantly greater than ultrasonography sensitivity (92%, 95% CI 84% to 96%), with a 5% difference (95% CI 1% to 9%). For small bowel Crohn’s disease presence, magnetic resonance enterography specificity was 96% (95% CI 86% to 99%) and ultrasonography specificity was 84% (95% CI 65% to 94%), with a 12% difference (95% CI 0% to 25%). Test sensitivities for small bowel Crohn’s disease presence and extent were similar in the two cohorts. For colonic Crohn’s disease presence in newly diagnosed participants, ultrasonography sensitivity (67%, 95% CI 49% to 81%) was significantly greater than magnetic resonance enterography sensitivity (47%, 95% CI 31% to 64%), with a 20% difference (95% CI 1% to 39%). For active small bowel Crohn’s disease, magnetic resonance enterography sensitivity (96%, 95% CI 92% to 99%) was significantly greater than ultrasonography sensitivity (90%, 95% CI 82% to 95%), with a 6% difference (95% CI 2% to 11%). There was some disagreement between readers for both tests. A total of 88% of participants rated magnetic resonance enterography as very or fairly acceptable, which is significantly lower than the percentage (99%) of participants who did so for ultrasonography. Therapeutic decisions based on magnetic resonance enterography alone and ultrasonography alone agreed with the final decision in 122 out of 158 (77%) cases and 124 out of 158 (78%) cases, respectively. There were no differences in costs or quality-adjusted life-years between tests. Limitations Magnetic resonance enterography and ultrasonography scans were interpreted by practitioners blinded to clinical data (but not participant cohort), which does not reflect use in clinical practice. Conclusions Magnetic resonance enterography has higher accuracy for detecting the presence, extent and activity of small bowel Crohn’s disease than ultrasonography does. Both tests have variable interobserver agreement and are broadly acceptable to participants, although ultrasonography produces less participant burden. Diagnostic impact and cost-effectiveness are similar. Recommendations for future work include investigation of the comparative utility of magnetic resonance enterography and ultrasonography for treatment response assessment and investigation of non-specific abdominal symptoms to confirm or refute Crohn’s disease. Trial registration Current Controlled Trials ISRCTN03982913. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 42. See the NIHR Journals Library website for further project information.

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Section: Existing Literature On the Diagnostic Accuracy Of Magnetic Rmentioning

confidence: 99%

Magnetic resonance enterography compared with ultrasonography in newly diagnosed and relapsing Crohn’s disease patients: the METRIC diagnostic accuracy study

Taylor

Mallett

Bhatnagar

et al. 2019

Health Technol Assess

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“…Whereas, in established CD cases, the diagnostic yield of CE compared with enteroclysis was greater and CE identified significantly more lesions in the terminal ileum as compared with ileoscopy. 30 The European Society of Gastrointestinal Endoscopy (ESGE) and European Crohn's and Colitis Organization guidelines advocate the use of validated endoscopic scoring indices for the classification of inflammatory activity in patients with CD undergoing SBCE, such as the Lewis score 31 or the Capsule Endoscopy Crohn's Disease Activity Index or Niv score. 32 With the new "treat-to-target" concept of achieving mucosal healing as the final goal of treatment, CE is presumed to have a central role in evaluating the SB mucosal healing.…”

Section: Clinical Evidence For Use Obscure Gastrointestinal Bleedingmentioning

confidence: 99%

Capsule Endoscopy: What We Know and What Is New in the Horizon

Chauhan

Tanwar

Nijhawan

2019

Journal of Digestive Endoscopy

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Capsule endoscopy (CE) is an advancing noninvasive technology primarily meant for small-bowel visualization, which has expanded its scope and has become a game changer in evaluation and management of various gastrointestinal (GI) diseases with special emphasis on obscure GI bleeding. The aim of this review is to know the basic aspects of CE and recent advances with clinical evidence. AbstractKeywords ► capsule endoscopy ► celiac disease ► Crohn's disease ► obscure gastrointestinal bleed ► small bowel

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“…When CD involves the small bowel distal to the duodenum and proximal to the terminal ileum, ileo-colonoscopy may result in a negative finding. Overall, CE is a recommended tool for patients with clinical features suggestive of CD but with negative ileo-colonoscopy findings [ 8 , 15 , 16 , 20 ]. CE is also helpful for reclassifying patients with colonic IBD who are not classified as having CD or UC.…”

Section: Capsule Endoscopymentioning

confidence: 99%

Balloon-Assisted Enteroscopy and Capsule Endoscopy in Suspected Small Bowel Crohn’s Disease

et al. 2017

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Inflammatory bowel diseases are idiopathic inflammatory diseases of two main types, Crohn’s disease and ulcerative colitis. Crohn’s disease can affect the entire gastrointestinal tract, and the distal ileum is involved in up to 70% of patients. Moreover, Crohn’s disease in one-quarter to one-third of patients involves isolation of the small bowel. Due to the nonspecific symptoms and anatomical location of the disease, small bowel Crohn’s disease is a phenotype that is particularly difficult to manage. Since the introduction of capsule endoscopy in 2000 and balloon-assisted enteroscopy in the 21st century, it is now possible to directly inspect for small bowel Crohn’s disease. However, the new modalities still have limitations, such as capsule retention and invasiveness of balloon-assisted enteroscopy. The diagnostic yields of both capsule endoscopy and balloon-assisted enteroscopy are high for patients with suspected small bowel Crohn’s disease. Therefore, earlier use of capsule endoscopy or balloon-assisted enteroscopy can help with the diagnosis and earlier treatment of these patients to avert possible disastrous outcomes.

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Effectiveness of Capsule Endoscopy Compared with Other Diagnostic Modalities in Patients with Small Bowel Crohn’s Disease: A Meta-Analysis

Cited by 40 publications

References 40 publications

Magnetic resonance enterography compared with ultrasonography in newly diagnosed and relapsing Crohn’s disease patients: the METRIC diagnostic accuracy study

Magnetic resonance enterography compared with ultrasonography in newly diagnosed and relapsing Crohn’s disease patients: the METRIC diagnostic accuracy study

Capsule Endoscopy: What We Know and What Is New in the Horizon

Balloon-Assisted Enteroscopy and Capsule Endoscopy in Suspected Small Bowel Crohn’s Disease

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