Peer-Reviewed Journal Details
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Solem, CA,Loftus, EV,Fletcher, JG,Baron, TH,Gostout, CJ,Petersen, BT,Tremaine, WJ,Egan, LJ,Faubion, WA,Schroeder, KW,Pardi, DS,Hanson, KA,Jewell, DA,Barlow, JM,Fidler, JL,Huprich, JE,Johnson, CD,Harmsen, WS,Zinsmeister, AR,Sandborn, WJ
2008
August
Gastrointest Endosc
Small-bowel imaging in Crohn's disease: a prospective, blinded, 4-way comparison trial
Published
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Optional Fields
COMPUTED-TOMOGRAPHY ENTEROCLYSIS WIRELESS CAPSULE ENDOSCOPY ORAL CONTRAST MATERIAL BARIUM FOLLOW-THROUGH CT ENTEROGRAPHY SMALL-INTESTINE PROSPECTIVE MULTICENTER COLONOSCOPIC FINDINGS CLINICAL-APPLICATIONS PUSH ENTEROSCOPY
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266
Background: With the introduction of new techniques to image the small bowel, there remains uncertainty about their role for diagnosing, Crohn's disease.Objective: To assess the sensitivity and specificity of capsule endoscopy (CE), CT enterography (CTE), ileocolonoscopy, and small-bowel follow-through (SBFT) in the diagnosis of small bowel Crohn's disease.Methods: Prospective, blinded trial.Setting: Inflammatory bowel disease clinic at in academic medical center.Patients: Known or suspected Crohn's disease. Exclusion criteria included known abdominal abscess and non-steroidal anti-inflammatory drug (NSAID) use. Partial small-bowel obstruction (PSBO) at CTE excluded patients from subsequent CE.Interventions: Patients underwent all 4 tests over a 4-day period.Main Outcome Measurements: Sensitivity, specificity, and accuracy of each test to detect active small-bowel Crohn's disease. The criterion standard was a consensus diagnosis based upon clinical presentation and all 4 studies.Results: Forty-one CTE examinations were performed. Seven patients (17%) had an asymptomatic PSBO. Forty patients underwent colonoscopy, 38 had SBFT studies, and 28 had CE examinations. Small-bowel Crohn's disease was active, in 51%, absent in 42%, inactive in 5%, and supicious in 2% of patients. The sensitivity of CE for detecting active small-bowel Crohn's disease was 83%, not significantly higher than CTE (83%), ileocolonoscopy (74%), or SBFT (65%). However, the specificity of CE (53%) was significantly lower than the other tests (P < .05). One patient developed a transient PSBO due to CE, but no patients had retained capsules.Limitation: Use of a consensus clinical diagnosis as the criterion standard-but this is how Crohn's disease is diagnosed in practice.Conclusions: The sensitivity of CF for active small-bowel Crohn's disease was not significantly different from CTE, ileocolonoscopy, or SBFT However, lower specificity and the need for preceding small-bowel radiography (due to the high frequency of asymptomatic PSBO) may limit the utility of CE as a first-line test for Crohn's disease.
DOI 10.1016/j.gie.2008.02.017
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