Original article—alimentary tract
Diagnostic Accuracy of Capsule Endoscopy for Small Bowel Crohn's Disease Is Superior to That of MR Enterography or CT Enterography

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Background & Aims

Capsule endoscopy (CE) detects small bowel Crohn's disease with greater diagnostic yield than radiologic procedures, although there are concerns that CE has low specificity. We compared the sensitivity and specificity of CE, magnetic resonance imaging enterography (MRE) and computed tomography enterography (CTE) in patients with suspected or newly diagnosed Crohn's disease.

Methods

We performed a prospective, blinded study of 93 patients scheduled to undergo ileocolonoscopy, MRE, and CTE and subsequently CE if stenosis was excluded. Physicians reporting CE, MRE, and CTE results were blinded to patient histories and findings from ileocolonoscopy and other small bowel examinations. Results were compared with those from ileoscopy (n = 70), ileoscopy and surgery (n = 4), or surgery (n = 1).

Results

Twenty-one patients had Crohn's disease in the terminal ileum. The sensitivity and specificity for diagnosis of Crohn's disease of the terminal ileum were 100% and 91% by CE, 81% and 86% by MRE, and 76% and 85% by CTE, respectively. Proximal Crohn's disease was detected in 18 patients by using CE, compared with 2 and 6 patients by using MRE or CTE, respectively (P < .05). Small bowel stenosis was observed in 5 patients by using CTE and 1 patient by using MRE. Cross-sectional imaging results indicated additional stenoses in only 2 of the patients who received complete ileocolonoscopies.

Conclusions

In suspected or newly diagnosed Crohn’s disease, MRE and CTE have comparable sensitivities and specificities. In patients without endoscopic or clinical suspicion of stenosis, CE should be the first line modality for detection of small bowel Crohn's disease beyond the reach of the colonoscope.

Section snippets

Materials and Methods

This prospective, blinded, multicenter study recruited patients from 4 centers managing adult patients with inflammatory bowel diseases (http://ClinicalTrials.gov Identifier NCT01019460). Patients were recruited during a 22-month period starting October 2007. All patients had a standardized work-up including medical history, physical examination, blood and stool samples, and ileocolonoscopy. MRE and CTE were performed on the same day at a single center. Subsequently, CE was performed in

Results

A total of 104 patients were included in the study (Figure 1). Eleven patients were excluded before small bowel examinations; 9 patients withdrew their consent for participation, 1 patient was admitted to the hospital and underwent acute examinations, and 1 patient was unable to complete both MRE and CTE and was excluded. Characteristics of 93 patients examined in the study protocol are shown in Table 1.

On the basis of symptoms, clinical, and biochemical findings and the result of

Discussion

Still today, CD is a syndrome diagnosis based on the clinical presentation and findings at endoscopy, histology, and small bowel radiology.12 For assessing the small intestine, small bowel follow-through and enteroclysis are challenged by new cross-sectional imaging modalities and endoscopic methods and are no longer generally accepted as gold standards.10, 12 Studies evaluating and comparing new modalities are needed to establish the optimal diagnostic strategies in patient subgroups.

In the

Acknowledgments

Many thanks to the following colleagues for participation in this study: Troels Havelund, PhD, Dr Benedicte Wilson, Jane Møller Hansen, PhD, Dr Laurits Laursen, Dr Finn Møller Pedersen, Professor Ove B. Schaffalitzky de Muckadell, DMSci, and Karsten Lauritsen, DMSci, Department of Medical Gastroenterology, Odense University Hospital, Denmark; Dr Anette Hygum Knudsen, Dr Ejler Ejlersen, Bent Nyboe Andersen, DMSci, and Henrik Hey, DMSci, Department of Internal Medicine, Section of

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Conflicts of interest The authors disclose no conflicts.

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