Crohn disease of the small bowel: preliminary comparison among CT enterography, capsule endoscopy, small-bowel follow-through, and ileoscopy.
OBJECTIVE
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.


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.


CONCLUSIONS
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.
Hara
Amy K
AK
Department of Diagnostic Radiology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259, USA. hara.amy@mayo.edu
Leighton
Jonathan A
JA
Heigh
Russell I
RI
Sharma
Virender K
VK
Silva
Alvin C
AC
De Petris
Giovanni
G
Hentz
Joseph G
JG
Fleischer
David E
DE
D000293:Adolescent; D000328:Adult; D000368:Aged; D001466:Barium Sulfate / Q000008:administration & dosage; D002214:Capsules; D003287:Contrast Media / Q000008:administration & dosage; D003424:Crohn Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007082:Ileum / Q000473:pathology; D007421:Intestine, Small / Q000473:pathology; D007472:Iohexol / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D008904:Miniaturization; D014057:Tomography, X-Ray Computed
D002214:Capsules; D003287:Contrast Media; D001466:Barium Sulfate; D007472:Iohexol