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Comparison among CT Enterography, Capsu

Crohn Disease of the Small Bowel: Preliminary Comparison among CT Enterography, Capsule Endoscopy, Small-Bowel Follow-through, and Ileoscopy
Amy K. Hara, MD, Jonathan A. Leighton, MD, Russell I. Heigh, MD, Virender K. Sharma, MD, Alvin C. Silva, MD, Giovanni De Petris, MD, Joseph G. Hentz, MS and David E. Fleischer, MD
+ Author Affiliations

1From the Department of Diagnostic Radiology (A.K.H., A.C.S.), Division of Gastroenterology and Hepatology (J.A.L., R.I.H., V.K.S., D.E.F.), Department of Laboratory Medicine/Pathology (G.D.P.), and Division of Biostatistics (J.G.H.), Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259. Received February 20, 2005; revision requested April 19, 2005; revision received April 30, 2005; accepted June 13, 2005.
Address correspondence to
A.K.H. (e-mail: hara.amy@mayo.edu).

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Abstract

Purpose: To prospectively compare four diagnostic small-bowel imaging techniques for depiction of abnormal findings in the same patients known to have or suspected of having Crohn disease.

Materials and Methods: Institutional review board approval and informed consent were obtained. Patients known to have or suspected of having nonobstructive Crohn disease were recruited. Each patient underwent capsule endoscopy, computed tomographic (CT) enterography, colonoscopy with ileoscopy, and small-bowel follow-through (SBFT). Findings consistent with Crohn disease were tabulated for each imaging examination (diagnostic yield). The proportions of patients with positive findings at each examination were compared, and any significant differences between the tests were calculated by using the exact McNemar test.

Results: Seventeen patients (nine women, eight men; mean age, 49 years; range, 18–78 years) completed the study out of 20 patients enrolled. Crohn disease was depicted by capsule endoscopy in 12 patients (71%), ileoscopy in 11 (65%), CT enterography in nine (53%), and SBFT in four (24%). Ileoscopy was incomplete in four patients, and capsule endoscopy was incomplete in two patients. Capsule endoscopy had the highest diagnostic yield for Crohn disease, and SBFT had the lowest, but these differences were not statistically significant (P = .02). SBFT failed to depict a stricture in one patient, which resulted in surgical removal of the capsule. CT enterography and SBFT depicted extraintestinal findings (eg, mesenteric adenopathy in two patients, perianal and enterocolic fistulas in one patient) not detected endoscopically.

Conclusion: This preliminary study demonstrates capsule endoscopy and CT enterography may depict nonobstructive Crohn disease when techniques such as ileoscopy and SBFT have negative or inconclusive findings.

© RSNA, 2006

Crohn disease is an inflammatory bowel disease that is characterized by mucosal and transmural inflammation and that involves the small intestine in about 70% of patients. As many as 30% of patients with Crohn disease have lesions limited to the small intestine, usually the ileum (1).

Current techniques for diagnosing Crohn disease in the small bowel have been conventional endoscopy and radiologic barium examinations. Conventional endoscopy, although it provides a direct view of the mucosal surface, is limited to the proximal small bowel or to the distal terminal ileum (in which case it is termed ileoscopy). Ileoscopy is further compromised by the occasional inability to reach the cecum or intubate the ileum during colonoscopy. Although barium small-bowel follow-through (SBFT) can effectively depict transmural disease, it may be imprecise for depicting mild disease, such as aphthous ulcers or other subtle mucosal abnormalities (2).

Newer techniques, such as capsule endoscopy and computed tomographic (CT) enterography, have the ability to provide a complete small-bowel evaluation. Capsule endoscopy provides a direct and more extensive mucosal evaluation than standard endoscopy does, whereas CT enterography has the ability to depict subtle findings such as mucosal hypervascularity or mild wall thickening, which are not depicted by standard barium examinations. Although previous studies have compared capsule endoscopy with barium examinations or CT separately, to our knowledge a comparison among all four diagnostic techniques in the same patients has not yet been performed.

Thus, the aim of our study was to compare four diagnostic small-bowel imaging techniques (CT enterography, capsule endoscopy, SBFT, and ileoscopy) for depiction of abnormal findings in the same patients known to have or suspected of having Crohn disease.

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MATERIALS AND METHODS

Patients

All consecutive patients known to have or suspected of having Crohn disease who were referred to the inflammatory bowel disease clinic at our institution were screened for inclusion in the study, which was approved by our institutional review board. All patients provided informed consent for this Health Insurance Portability and Accountability Act-compliant study and were informed of the radiation exposure associated with this study.

Inclusion criteria included being aged 18 or older and being suspected of having or having Crohn disease of the small bowel on the basis of positive imaging, pathologic, or endoscopic findings. Exclusion criteria for capsule endoscopy included pregnancy, small-bowel stricture or obstruction identified at SBFT or CT, or clinically important swallowing disorder. Patients with a cardiac pacemaker or other electromedical device were also excluded due to theoretical concern that the capsule could interfere with pacemaker function. Since that time, it has been shown that capsule endoscopy can be performed safely in patients with pacemakers (3). Patients also were excluded due to contraindications to colonoscopy, such as ischemic bowel disease or acute diverticulitis.

If a patient underwent ileoscopy or SBFT within 6 months prior to enrollment, the study was not repeated. All capsule endoscopic and CT enterographic studies were performed at our institution, whereas two ileoscopic examinations and two SBFTs were performed at other institutions. The results of biopsies performed at other institutions were not submitted to our institution for independent review. Prior to capsule endoscopy, all patients underwent SBFT (n = 3), CT enterography (n = 2), or both (n = 12) to exclude a small-bowel stricture or obstruction. The patient's electronic medical record was reviewed to determine if a patient had received medical treatment between any of the examinations. The average interval between the first and the last of the four examinations was 20 weeks (range, 2–41 weeks).

Imaging Examinations

All SBFTs were single-contrast barium examinations. SBFT performed at our institution (15 of 17) was performed with 400–600 mL of barium sulfate suspension (Entrobar; Lafayette Pharmaceuticals, Lafayette, Ind) and intermittent palpation and fluoroscopic evaluation performed at 20–30-minute intervals until the terminal ileum was visualized. At our institution all SBFTs were performed by one of five board-certified radiologists with 3–15 years of experience with barium examinations. All images were digital.

Before they underwent CT enterography, patients were instructed to drink 1500 mL of water: Five hundred milliliters of water was given at 45 minutes, at 30 minutes, and at 15 minutes before the procedure. During scanning, 150 mL of nonionic intravenous contrast medium (iohexol, Omnipaque 350; Amersham Health, Princeton, NJ) was administered at a rate of 3 mL/sec, and the imaging was conducted 40 seconds after administration of the intravenous contrast medium was started. A multi–detector row CT scanner (Volume Zoom; Siemens Medical Systems, Iselin, NJ) was used with the following scanning parameters: 2.5-mm detector width, 3-mm effective section thickness, 200 mA, 1.5-mm reconstruction interval, and 120 kVp. Coronal reconstructions at 3 mm were also obtained. The CT enterographic images were evaluated by one board-certified abdominal radiologist (A.C.S.) with 3 years of experience interpreting CT enterographic images. The radiologist was not informed about patient history or the results of any ileoscopic, SBFT, or capsule endoscopic procedures already conducted.

Capsule Endoscopy and Ileoscopy

Capsule endoscopy (Given Diagnostic System; Given Imaging, Yoqneam, Israel) was performed in a standard manner. Bowel preparation consisted of the patient consuming only clear liquids on the day before the procedure and nothing by mouth after 10:00 PM. The sensor array was applied with adhesive pads to the patient's skin and was connected to the data recorder and battery pack. The capsule was activated and then swallowed by the patient with a glass of water. At 2 hours after swallowing the capsule, the patient was permitted to drink fluids, and at 4 hours the patient was allowed to eat solid food. Patients were instructed to return in 8 hours to remove the sensor array and data recorder, and then data were downloaded into a computer. Capsule endoscopic results were interpreted by three board-certified gastroenterologists (J.A.L., V.K.S., D.E.F.) with at least 3 years of experience interpreting capsule endoscopic results.

Ileoscopy was performed following colonoscopy by using a standard bowel preparation with 4 L of polyethylene glycol solution (GoLytely; Braintree Laboratories, Braintree, Mass). Ileoscopy was performed by one of 10 different board-certified gastroenterologists (J.A.L., D.E.F., R.I.H.) with 8–20 years of endoscopy experience; they were unblinded to patient history or previous imaging results. Ileal biopsy specimens were obtained with the endoscope by using standard biopsy forceps.

Interpretation of Findings

An examination (SBFT, CT enterography, capsule endoscopy, or colonoscopy) finding was defined as positive if it demonstrated any lesion in the small bowel consistent with Crohn disease. For example, ileoscopic and capsule endoscopic findings were considered positive if erosions, ulcers, or strictures were found. Ileoscopic findings were also considered positive if findings from biopsy specimens were consistent with Crohn disease. A positive SBFT finding consisted of abnormal nodularity, loss of normal mucosal folds, linear ulcers, strictures, or fistulas. CT enterographic abnormalities were defined as increased mucosal or wall enhancement of affected small-bowel loops compared with nonaffected small-bowel loops, bowel-wall thickening more than 3 mm, fistulas, or abscesses. The approximate location and specific type of small-bowel abnormality detected with each examination were recorded. The number of positive findings obtained with each technique was tabulated to calculate diagnostic yield.

In general, the individual mucosal breaks identified with endoscopy were not expected to be visualized at imaging. Instead, imaging findings that correlated with endoscopic abnormalities included more diffuse small-bowel wall involvement such as thickening (depicted by SBFT and CT enterography), nodularity (depicted by SBFT), or increased enhancement (depicted by CT enterography). Strictures can be seen with both endoscopic and imaging examinations, while abscesses or fistulas usually are not seen at endoscopy.

An incomplete examination was defined as any examination that did not provide definitive visualization of the terminal ileum. For example, if capsule endoscopy or SBFT did not depict the cecum, it was an incomplete examination. Conversely, if the ileum could not be intubated at colonoscopy, the examination was considered incomplete. All CT enterographic examinations included the terminal ileum; therefore, none were considered incomplete.

Statistical Analysis

The proportions of patients with positive Crohn disease findings at any examination were compared, and any significant differences between the tests were calculated by using the exact McNemar test (4). For six pairwise comparisons, nominal P values of less than .008 indicated statistical significance at the 5% level. Computations were performed by using statistical software (StatXact, version 5; Cytel Software, Cambridge, Mass). The Bonferroni method was used to account for multiple comparisons.

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RESULTS

Patients

Twenty consecutive patients known to have or suspected of having Crohn disease and who met the inclusion criteria were included in the study. Of these 20 patients, three were later excluded: one for refusal to undergo capsule endoscopy after CT enterography, one for refusal to undergo any examinations despite having signed consent forms, and one for not undergoing capsule endoscopy after CT enterographic findings were suspicious for small-bowel obstruction. The mean age of the 17 participants (nine women, eight men) who completed the study was 49 years (range, 18–78 years). Nine patients had an established diagnosis of Crohn disease, and eight patients were suspected of having Crohn disease.

Examinations Performed

The majority of ileoscopic examinations (15 of 17) and SBFTs (14 of 17) were performed before CT enterographic examinations or capsule endoscopic examinations. Four examinations were conducted at other institutions (two SBFTs and two ileoscopic examinations). All other SBFTs and ileoscopic examinations, all 17 CT enterographic examinations, and all 17 capsule endoscopic examinations were performed at our institution.

Incomplete examinations, defined as distal ileal evaluations not obtained, occurred in five patients: in two of 17 (12%) capsule endoscopic examinations and in four of 17 (24%) ileoscopic examinations. One patient had both an incomplete capsule endoscopy and an incomplete ileoscopy. One patient had a small-bowel stricture that was not detected with SBFT and required surgery 1 month after capsule endoscopy to remove the capsule. The retained capsule and the distal small-bowel stricture both were depicted at subsequent CT enterography. All scheduled SBFTs and CT enterographic examinations provided depiction of the entire small bowel.

Findings

Small-bowel findings (Figs 1, 2) positive for Crohn disease were present in 12 of 17 (71%) capsule endoscopic examinations, 11 of 17 (65%) ileoscopic examinations, and nine of 17 (53%) CT enterographic examinations, but in only four of 17 (24%) SBFTs (Tables 1, 2). For depiction of inflammatory bowel disease findings, capsule endoscopy produced the highest number of positive findings and SBFT the lowest number of positive findings, but the differences among the various techniques were not statistically significant. SBFT depicted Crohn disease less often than did capsule endoscopy or CT enterography (P ≤ .06). The proportion of positive findings at capsule endoscopy was 47.1% higher than the proportion of positive findings at SBFT, but the margin of error would be large for a sample this size.


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Figure 1a:
Crohn disease in a patient with incomplete findings at ileoscopy, negative findings at SBFT, and positive findings at CT enterography and capsule endoscopy. The capsule could not be passed due to a small-bowel stricture and was removed surgically. (a) Transverse image from CT enterography shows small-bowel stricture (arrow) and proximal small-bowel dilatation. High-attenuation material (circled) is a partially imaged retained capsule. (b) View at capsule endoscopy shows small-bowel stricture (★).


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Figure 1b:
Crohn disease in a patient with incomplete findings at ileoscopy, negative findings at SBFT, and positive findings at CT enterography and capsule endoscopy. The capsule could not be passed due to a small-bowel stricture and was removed surgically. (a) Transverse image from CT enterography shows small-bowel stricture (arrow) and proximal small-bowel dilatation. High-attenuation material (circled) is a partially imaged retained capsule. (b) View at capsule endoscopy shows small-bowel stricture (★).


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Figure 2a:
Crohn disease in a patient with negative findings at SBFT but positive findings at CT enterography, ileoscopy, and capsule endoscopy. (a) Transverse image from CT enterography shows marked abnormal wall thickening and enhancement (arrows) in terminal ileum, consistent with Crohn disease. (b) View at ileoscopy shows linear ulcers in terminal ileum (arrowheads). (c) View at capsule endoscopy shows large ulcer (arrowhead) and stricture (∗) in small intestine.


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Figure 2b:
Crohn disease in a patient with negative findings at SBFT but positive findings at CT enterography, ileoscopy, and capsule endoscopy. (a) Transverse image from CT enterography shows marked abnormal wall thickening and enhancement (arrows) in terminal ileum, consistent with Crohn disease. (b) View at ileoscopy shows linear ulcers in terminal ileum (arrowheads). (c) View at capsule endoscopy shows large ulcer (arrowhead) and stricture (∗) in small intestine.


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Figure 2c:
Crohn disease in a patient with negative findings at SBFT but positive findings at CT enterography, ileoscopy, and capsule endoscopy. (a) Transverse image from CT enterography shows marked abnormal wall thickening and enhancement (arrows) in terminal ileum, consistent with Crohn disease. (b) View at ileoscopy shows linear ulcers in terminal ileum (arrowheads). (c) View at capsule endoscopy shows large ulcer (arrowhead) and stricture (∗) in small intestine.

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Table 1.
Results of Small-Bowel Examinations Performed in the Same 17 Patients Known to Have or Suspected of Having Crohn Disease

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Table 2.
Comparison of Positive, Negative, and Incomplete Findings from Four Small-Bowel Techniques Performed in Patients Known to Have or Suspected of Having Crohn Disease

Ileoscopic and capsule endoscopic findings from complete examinations were concordant in eight of 12 (67%) cases and discordant in four of 12 (33%) cases. One patient with positive ileoscopic findings but negative capsule endoscopic findings underwent 6 weeks of medical therapy between the two procedures. Ileoscopy was incomplete in four patients; two of those patients had positive capsule endoscopic findings. Capsule endoscopy was incomplete in one patient with positive ileoscopic findings.

CT enterography did not depict Crohn disease in any patients other than those with positive Crohn disease findings at ileoscopy or capsule endoscopy. Similarly, SBFT did not depict Crohn disease in any patients other than those with positive Crohn disease findings at ileoscopy, CT enterography, or capsule endoscopy. CT enterography and SBFT did, however, demonstrate important extraenteric findings (including a perianal fistula and an enterocolic fistula in one patient) not detected with endoscopy. CT enterography also depicted mesenteric adenopathy (more than 1 cm) in one patient. Disease proximal to the distal ileum was depicted in eight patients by capsule endoscopy, in no patients by CT enterography, and in one patient by SBFT. Five patients with proximal or middle small-bowel disease had distal disease detected with ileoscopy.

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DISCUSSION

In this study comparing four diagnostic small-bowel techniques in the same patients known to have or suspected of having Crohn disease, SBFT depicted far less disease than did capsule endoscopy, CT enterography, or ileoscopy. The suboptimal performance of SBFT in evaluating patients with Crohn disease compared with the better performance of capsule endoscopy has also been observed in other studies (5–8). For example, Crohn disease was depicted at capsule endoscopy in 11 of 17 (65%) patients in one study and in 14 of 20 (70%) patients in the other study. All patients had negative SBFT findings (6,7).

Another study showed that capsule endoscopic findings could alter the original diagnoses of Crohn disease made with imaging. In that study, capsule endoscopic findings changed the diagnosis in 12 of 20 patients, by demonstrating Crohn disease in six of 20 patients with normal SBFT or CT enteroclysis findings, by allowing Crohn disease to be ruled out in three patients with suspicious imaging findings, and by demonstrating extended involvement of Crohn disease in three patients. The overall yield in that study of capsule endoscopy (70%) was significantly different than that of imaging (35%) (5).

The poor performance of SBFT is likely multifactorial. There is a technical disadvantage in using indirect methods of small-bowel evaluation, such as barium techniques, compared with direct methods of mucosal visualization, such as endoscopy. Poor technique can affect some barium examinations that use only timed overhead radiography instead of intermittent fluoroscopy and palpation performed by a radiologist. In addition, most studies that involve capsule endoscopy do not include patients with positive barium examination findings or patients with advanced disease and strictures or obstruction. The reasonable conclusion from most studies is that capsule endoscopic findings are often positive in patients with negative barium examination findings, not that barium examinations are inadequate for depicting all small-bowel disease.

In our study, CT enterography depicted more than twice as many cases of Crohn disease than did SBFT. In another study of 20 patients, CT enterography also correctly depicted more cases of Crohn disease (10 of 13) than did SBFT (eight of 13) (9). While our study had only one patient with fistulas, which were detected with both CT enterography and SBFT, other studies have demonstrated that CT is superior to SBFT in the depiction of extraluminal findings and complications of Crohn disease (10,11). In these studies, CT findings altered medical or surgical management in 28% of patients with Crohn disease (11).

Both types of endoscopy (capsule endoscopy and ileoscopy) depicted more findings of small-bowel Crohn disease than did CT enterography. The benefit of CT enterography may ultimately be in patients with more advanced Crohn disease who cannot undergo capsule endoscopy, because CT enterography can depict and facilitate the evaluation of obstructions, fistulas, and abscess formations. CT enterography may be a faster, more comfortable, and more sensitive technique than a barium examination in these patients. In addition, for patients in whom ileoscopy was unsuccessful, CT enterography may be used to rule out a stricture or obstruction before capsule endoscopy is performed. In fact, CT is now commonly used to rule out small-bowel obstruction in many clinical situations (12,13).

Some may argue that if enteroclysis or CT enteroclysis techniques had been used, more Crohn disease would have been depicted. Capsule endoscopy, however, appears to depict small-bowel ulcers, which cannot be depicted by radiologic imaging. For example, in one study two patients underwent state-of-the-art enteroclysis, which resulted in negative findings, even though the radiologist knew prior to the examination that multiple small-bowel ulcers had been depicted by capsule endoscopy (14). In another recent study of 41 patients with Crohn disease, capsule endoscopy depicted jejunal or ileal lesions in 25 patients, whereas CT enteroclysis (P = .004) depicted jejunal or ileal lesions in only 12 patients (15). The additional lesions depicted by capsule endoscopy were villous denudation, aphthoid ulcers, or erosions. While capsule endoscopy was better than CT enteroclysis for depicting jejunal and proximal to middle ileal lesions, there were no significant differences between the two techniques for the depiction of lesions in the terminal ileum (15).

The yield of ileoscopy was comparable to that of capsule endoscopy in our study. This similar yield supports the fact that ileoscopy is still a useful technique for the evaluation of patients with inflammatory bowel disease. The inability of ileoscopy to demonstrate mucosa proximal to the distal ileum, however, can result in false-negative diagnoses. In our study, two patients with proximal and middle small-bowel ulcers and erosions at capsule endoscopy had negative findings at ileoscopy. In addition, ileoscopy was incomplete in four patients, two of whom had positive small-bowel findings at capsule endoscopy and CT enterography. Therefore, while ileoscopy can successfully depict Crohn disease, capsule endoscopy or CT enterography still can play an important role, particularly in depicting proximal disease or for patients in whom the ileoscopy examination was incomplete.

While the results of capsule endoscopy are very promising, capsule endoscopy has several limitations. First, depiction of the small bowel at capsule endoscopy can be compromised by poor bowel preparation. Second, the capsule may not reach the cecum, which can result in an incomplete examination and false-negative result. Capsule endoscopy is also limited because it cannot be used to obtain biopsy specimens and because its use is restricted in patients with strictures.

A limitation of our study is its small sample size, which precluded any finding of statistical significance at the 5% level for the differences among multiple comparisons made among the four techniques. In addition, a reliable reference standard for diagnosing Crohn disease proximal to the terminal ileum is difficult. Although ileoscopy is reliable in depicting Crohn disease in the terminal ileum, ileoscopy cannot be used to definitively exclude Crohn disease if it occurs elsewhere in the small bowel but spares the terminal ileum. SBFT and enteroclysis demonstrate the entire small bowel, but in multiple studies they have been shown to be a poor reference standard for Crohn disease. Capsule endoscopy also is not a proved reference standard because “abnormalities” are found in up to 14% of asymptomatic adults (16). Because of this difficultly in relying on one method for depicting Crohn disease, we used diagnostic yield to compare techniques, which means that any positive finding is considered true-positive. The obvious weakness of this method is a false-positive finding could be incorrectly tabulated as true-positive. Finally, this study did not include evaluation of magnetic resonance enteroclysis or ultrasonographic techniques, which also can be useful in depicting Crohn disease (17–20).

Despite these limitations, our small study provides further evidence that a shift in the work-up of patients with nonobstructive Crohn disease is ongoing. Previously, patients with symptoms suggestive of Crohn disease were evaluated with only ileoscopy or SBFT. If either or both of these two techniques demonstrated positive findings, patients were treated accordingly. If the findings of these two examinations were negative, patients were assumed to have a functional disorder or some other disorder. On the basis of our findings, capsule endoscopy and CT enterography may help diagnose Crohn disease in patients with incomplete examinations or negative results at ileoscopy and SBFT. In patients with negative findings from standard work-up and no obstructive symptoms, capsule endoscopy may be performed to help detect proximal or subtle Crohn disease. In patients with obstructive symptoms, CT enterography can be performed initially; if CT enterographic findings are negative for Crohn disease and obstruction, then capsule endoscopy can be performed.

In conclusion, we believe our study is the first to compare CT enterographic, capsule endoscopic, ileoscopic, and SBFT examinations in the same patients known to have or suspected of having Crohn disease. Our results demonstrate that CT enterography, capsule endoscopy, and ileoscopy have a higher yield in depicting mild to moderate findings of Crohn disease than SBFT. Capsule endoscopy is better for assessing proximal or early mucosal disease, whereas CT enterography is better for detecting transmural and extraluminal abnormalities. Most important, capsule endoscopy and CT enterography may depict nonobstructive Crohn disease of the small bowel when conventional techniques such as ileoscopy or SBFT produce negative or inconclusive findings.

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ADVANCES IN KNOWLEDGE

Endoscopic techniques can be used to detect more small-bowel findings of Crohn disease than imaging techniques.

CT enterography depicts more cases of nonobstructive Crohn disease than does small-bowel follow-through.

Capsule endoscopy can be used to detect more proximal and middle small-bowel Crohn disease than do CT enterography and small-bowel follow-through.

On the basis of these preliminary results, the diagnostic algorithm for patients suspected of having nonobstructive Crohn disease may change to incorporate capsule endoscopy and/or CT enterography rather than small-bowel follow-through.

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Footnotes

Author contributions: Guarantor of integrity of entire study, A.K.H., J.A.L.; study concepts/study design or data acquisition or data analysis/interpretation, all authors; manuscript drafting or manuscript revision for important intellectual content, all authors; approval of final version of submitted manuscript, all authors; literature research, A.K.H., J.A.L., R.I.H., V.K.S.; clinical studies, A.K.H., J.A.L., R.I.H., V.K.S., A.C.S., G.D.P., D.E.F.; experimental studies, all authors; statistical analysis, V.K.S., J.G.H.; and manuscript editing, all authors

Abbreviation:
SBFT = small-bowel follow-through
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References

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article can be found here;
http://radiology.rsna.org/content/238/1/128.full
 

Dexky

To save time...Ask Dusty!
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I read the conclusion. I'll take Dusty's word for the rest:)!

CT Enterography is the one you are waiting for, isn't it Wendy?
 
Thankyou very much for a very interesting article. I think those in the undiagnosed club will find it of particular interest.

That is exactly what happened to me. I have proximal small bowel disease which didn't show on ct or sbft but did on capsule endoscopy. I didn't have ct enteroclysis though just standard ct with contrast. I didn't have a complete capsule study though either because the capsule was delayed in the most proximal diseased area. There is definately another affected area as I had bled a lot and the bleeding point wasn't reached.

The main issue for people like me and the method of diagnosis is no tissue diagnosis. My GI said he wasn't prepared to put me through yet more tests to get a tissue diagnosis unles absolutely necessary but I do wonder what will happen if I needed humira or remicade and whether the powers to be would allow it without a tissue diagnosis. Something I may broach with my consultant when I am feeling brave!
 
Thanks for this article. I am undiagnosed as of now but have been suffering for a few months. Colonoscopy and upper endoscopy both came back normal. CT scan showed some inflammation but my doctor wants to further investigate to be sure. He ordered the capsule endoscopy but unfortunately my insurance is refusing to pay, saying that it is not medically necessary.
We are fighting with them and this just proves that I have no other alternative but the pillcam in order to find out what is going on!
 
hey Dex
I am waiting for the ct enteroclysis - studying the same areas, just going a different way about doing it.
 
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