Small-bowel imaging in Crohn's disease: a prospective, blinded, 4-way comparison trial.
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.


METHODS
Inflammatory bowel disease clinic at an academic medical center.


METHODS
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.


METHODS
Patients underwent all 4 tests over a 4-day period.


METHODS
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 suspicious 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.


CONCLUSIONS
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 CE 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.
Solem
Craig A
CA
Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
Loftus
Edward V
EV
Fletcher
Joel G
JG
Baron
Todd H
TH
Gostout
Christopher J
CJ
Petersen
Bret T
BT
Tremaine
William J
WJ
Egan
Laurence J
LJ
Faubion
William A
WA
Schroeder
Kenneth W
KW
Pardi
Darrell S
DS
Hanson
Karen A
KA
Jewell
Debra A
DA
Barlow
John M
JM
Fidler
Jeff L
JL
Huprich
James E
JE
Johnson
C Daniel
CD
Harmsen
W Scott
WS
Zinsmeister
Alan R
AR
Sandborn
William J
WJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D001466:Barium Sulfate; D053704:Capsule Endoscopy / Q000379:methods*; D003113:Colonoscopy / Q000379:methods; D016001:Confidence Intervals; D003424:Crohn Disease / Q000175:diagnosis*; D003952:Diagnostic Imaging / Q000379:methods*; D004733:Enema; D005260:Female; D006801:Humans; D007421:Intestine, Small / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D014057:Tomography, X-Ray Computed
D001466:Barium Sulfate