Oral Presentation
Novel methods for the diagnosis of small bowel disease - South Hall (Room 3)
Monday, September 27, 2004, 11.00-12.30
Abstract: OP-G-1
Citation: Gut 2004; 53 (Suppl VI) A2
CAPSULE ENDOSCOPY IN DIAGNOSIS OF SMALL BOWEL CROHN'S
DISEASE: A PROSPECTIVE, MONOCENTRIC STUDY WITH COMPARISON
TO MRI AND ENTEROCLYSIS
J.G. Albert1, A. Reissmann1, F. Martiny1, E. Lotterer1, H.H. Nietsch1, K. Stock2, C. Behrmann2, J.
Lesske1, M.C. Goebel1, W.E. Fleig1
1 First Department of Internal Medicine, 2 Department of Radiology, Martin-Luther-University, Halle,
Germany
INTRODUCTION: Diagnosis of small bowel Crohn's disease (CD) has been impaired by the limited
endoscopic visualization of the intestinal mucosa. To evaluate modern diagnostic imaging methods,
we performed a controlled, prospective, and blinded trial comparing diagnostic potential of Capsule
Endoscopy (CE), magnetic resonance imaging (MRI), and conventional enteroclysis (SBE) in the
small bowel.
AIMS & METHODS: Eighty-one patients were screened for eligibility by a standard diagnostic
work-up, including physical examination, laboratory investigations, microbiological stool tests,
abdominal ultrasonography, ileo-colonoscopy, and upper endoscopy. In twenty-nine patients,
diagnosis could be established with these diagnostic means, and no further testing was indicated.
In the remaining 53 patients, small bowel imaging was performed by CE, MRI, and enteroclysis. To
exclude bowel strictures, abdominal ultrasonography and either enteroclysis or MRI were
performed before CE. For CE, all patients were required to drink 2000ml of a bowel purgative
before the investigation and Simethicone was given prior to capsule ingestion.
RESULTS: Of the 53 patients investigated, 28 presented with established, and 25 with suspected
CD. In the latter, a diagnosis of CD could be confirmed in 14 cases (56%) after complete diagnostic
work-up. Inflammatory small bowel lesions typical for CD were seen by CE in 12 of 13 cases. In
fourteen patients high grade bowel stricture was detected, eight of whom had been operated 3 to
14 years (mean: 6.2 years; SD: 4.10) earlier. Results for suspected CD are shown in table 1. In
established CD, CE detected 13/14 (92.9%), MRI 11/14 (78.6%), and SBE 4/12 (33.3%) of small
bowel lesions. CE was exclusively diagnostic for the final diagnosis in suspected CD in three
patients, and in deteriorating CD in two patients.
TABLE 1. Sensitivity and specificity for small bowel lesions in suspected CD (N=
Sensitivity
Specificity
CE
MRI
SBE
12/13 (92.3%)
11/11 (100%)
10/13 (76.9%)
8/10 (80%)
3/9 (33%)
5/6 (83%)
CONCLUSION: CE is most sensitive in detection of even subtle mucosal lesions of small bowel CD
but is limited by stricturing disease. MRI represents a complementary means to CE and SBE
seems to be replaceable by CE and MRI in most cases.