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Small bowel Crohn's disease: MR enteroclysis and capsule endoscopy compared to balloon-assisted enteroscopy.

Wiarda BM, Mensink PB, Heine DG, Stolk M, Dees J, Hazenberg H, Stoker J, van der Woude CJ, Kuipers EJ - Abdom Imaging (2012)

Bottom Line: CE was complicated by capsule retention in one patient.MRE has a higher sensitivity and PPV than CE in small bowel CD.The use of CE is considerably limited by the high prevalence of stenotic lesions in these patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Medical Center Alkmaar, The Netherlands. b.m.wiarda@mca.nl

ABSTRACT
New modalities are available to visualize the small bowel in patients with Crohn's disease (CD). The aim of this study was to compare the diagnostic yield of magnetic resonance enteroclysis (MRE) and capsule endoscopy (CE) to balloon-assisted enteroscopy (BAE) in patients with suspected or established CD of the small bowel. Consecutive, consenting patients first underwent MRE followed by CE and BAE. Patients with high-grade stenosis at MRE did not undergo CE. Reference standard for small bowel CD activity was a combination of BAE and an expert panel consensus diagnosis. Analysis included 38 patients, 27 (71%) females, mean age 36 (20-74) years, with suspected (n = 20) or established (n = 18) small bowel CD: 16 (42%) were diagnosed with active CD, and 13 (34%) by MRE with suspected high-grade stenosis, who consequently did not undergo CE. The reference standard defined high-grade stenosis in 10 (26%) patients. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value of MRE and CE for small bowel CD activity were 73 and 57%, 90 and 89%, 88 and 67%, and 78 and 84%, respectively. CE was complicated by capsule retention in one patient. MRE has a higher sensitivity and PPV than CE in small bowel CD. The use of CE is considerably limited by the high prevalence of stenotic lesions in these patients.

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39-Year-old female patient with known CD and postoperative ileocecal resection 3 years earlier. Patient complaints were abdominal pain and diarrhea. MRE showed on coronal T1 3d fat-sat image (A) after contrast injection, normal anastomosis (arrows) of the neo-ileocecal junction without bowel wall thickening or increased contrast enhancement. CE (B) and BAE (C) both indicated superficial ulcerations on the level of the anastomosis (arrows). No other abnormalities were diagnosed.
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Fig3: 39-Year-old female patient with known CD and postoperative ileocecal resection 3 years earlier. Patient complaints were abdominal pain and diarrhea. MRE showed on coronal T1 3d fat-sat image (A) after contrast injection, normal anastomosis (arrows) of the neo-ileocecal junction without bowel wall thickening or increased contrast enhancement. CE (B) and BAE (C) both indicated superficial ulcerations on the level of the anastomosis (arrows). No other abnormalities were diagnosed.

Mentions: MRE showed a higher rate of detection of moderate to severe CD activity compared to CE (17 vs. 3%). However, the exclusion of patients with suspected stenotic disease for subsequent CE (Figs. 1, 2) largely influenced this outcome. CE showed a higher detection rate of lesions in mild CD activity patients (Table 2; Fig. 3). These results (Table 3) correspond with a sensitivity of 74 and 57%, specificity of 90 and 89%, PPV of 88 and 67%, and NPV of 78 and 84%, for detection of small bowel CD lesions by MRE and CE, respectively.Fig. 1


Small bowel Crohn's disease: MR enteroclysis and capsule endoscopy compared to balloon-assisted enteroscopy.

Wiarda BM, Mensink PB, Heine DG, Stolk M, Dees J, Hazenberg H, Stoker J, van der Woude CJ, Kuipers EJ - Abdom Imaging (2012)

39-Year-old female patient with known CD and postoperative ileocecal resection 3 years earlier. Patient complaints were abdominal pain and diarrhea. MRE showed on coronal T1 3d fat-sat image (A) after contrast injection, normal anastomosis (arrows) of the neo-ileocecal junction without bowel wall thickening or increased contrast enhancement. CE (B) and BAE (C) both indicated superficial ulcerations on the level of the anastomosis (arrows). No other abnormalities were diagnosed.
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Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3345178&req=5

Fig3: 39-Year-old female patient with known CD and postoperative ileocecal resection 3 years earlier. Patient complaints were abdominal pain and diarrhea. MRE showed on coronal T1 3d fat-sat image (A) after contrast injection, normal anastomosis (arrows) of the neo-ileocecal junction without bowel wall thickening or increased contrast enhancement. CE (B) and BAE (C) both indicated superficial ulcerations on the level of the anastomosis (arrows). No other abnormalities were diagnosed.
Mentions: MRE showed a higher rate of detection of moderate to severe CD activity compared to CE (17 vs. 3%). However, the exclusion of patients with suspected stenotic disease for subsequent CE (Figs. 1, 2) largely influenced this outcome. CE showed a higher detection rate of lesions in mild CD activity patients (Table 2; Fig. 3). These results (Table 3) correspond with a sensitivity of 74 and 57%, specificity of 90 and 89%, PPV of 88 and 67%, and NPV of 78 and 84%, for detection of small bowel CD lesions by MRE and CE, respectively.Fig. 1

Bottom Line: CE was complicated by capsule retention in one patient.MRE has a higher sensitivity and PPV than CE in small bowel CD.The use of CE is considerably limited by the high prevalence of stenotic lesions in these patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Medical Center Alkmaar, The Netherlands. b.m.wiarda@mca.nl

ABSTRACT
New modalities are available to visualize the small bowel in patients with Crohn's disease (CD). The aim of this study was to compare the diagnostic yield of magnetic resonance enteroclysis (MRE) and capsule endoscopy (CE) to balloon-assisted enteroscopy (BAE) in patients with suspected or established CD of the small bowel. Consecutive, consenting patients first underwent MRE followed by CE and BAE. Patients with high-grade stenosis at MRE did not undergo CE. Reference standard for small bowel CD activity was a combination of BAE and an expert panel consensus diagnosis. Analysis included 38 patients, 27 (71%) females, mean age 36 (20-74) years, with suspected (n = 20) or established (n = 18) small bowel CD: 16 (42%) were diagnosed with active CD, and 13 (34%) by MRE with suspected high-grade stenosis, who consequently did not undergo CE. The reference standard defined high-grade stenosis in 10 (26%) patients. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value of MRE and CE for small bowel CD activity were 73 and 57%, 90 and 89%, 88 and 67%, and 78 and 84%, respectively. CE was complicated by capsule retention in one patient. MRE has a higher sensitivity and PPV than CE in small bowel CD. The use of CE is considerably limited by the high prevalence of stenotic lesions in these patients.

Show MeSH
Related in: MedlinePlus