A prospective study of MR enterography versus capsule endoscopy for the surveillance of adult patients with Peutz-Jeghers syndrome.
OBJECTIVE
The objective of our study was to assess the utility of MR enterography compared with capsule endoscopy for the detection of small-bowel polyps in patients with Peutz-Jeghers syndrome (PJS).


METHODS
Adult patients with PJS scheduled for surveillance capsule endoscopy were prospectively recruited and underwent MR enterography and capsule endoscopy. Polyps > 10 mm were regarded as clinically relevant. When appropriate, large polyps (> 15 mm) were removed at enteroscopy, enabling correlation with MR enterography and capsule endoscopy findings. Interobserver agreement for MR enterography and capsule endoscopy was calculated. Patient comfort, convenience, and test preference were assessed.


RESULTS
Nineteen patients (median age, 39.6 years) underwent both procedures. There was no significant difference between techniques for the detection of polyps > 10 mm (18 vs 23 polyps at capsule endoscopy and MR enterography, respectively; p = 0.35) or in the number of patients in whom > 10 mm polyps were detected (eight vs 11 patients at capsule endoscopy and MR enterography, respectively; p = 0.38). However, in three patients, large polyps (> 15 mm) detected on MR enterography were not detected on capsule endoscopy; large polyps were seen in six patients at capsule endoscopy and in nine patients at MR enterography (p = 0.25). Interobserver agreement was high for MR enterography but was only fair for capsule endoscopy (kappa = 0.81 and 0.27, respectively). Size assessments of large polyps (> 15 mm) appeared more reproducible with MR enterography than with capsule endoscopy. Patients rated capsule endoscopy as more comfortable than MR enterography. There was no significant difference between the techniques with regard to patient convenience or preference.


CONCLUSIONS
MR enterography is a promising alternative to capsule endoscopy for small-bowel surveillance in adults with PJS. Although our results suggest that capsule endoscopy is more comfortable for the patient, MR enterography may be less prone to missing large polyps and may be more reliable in their size assessment.
Gupta
Arun
A
Intestinal Imaging Department, St. Mark's Hospital, London, United Kingdom. doctorarungupta@yahoo.co.uk <doctorarungupta@yahoo.co.uk>
Postgate
Aymer J
AJ
Burling
David
D
Ilangovan
Rajapandian
R
Marshall
Michele
M
Phillips
Robin K S
RK
Clark
Susan K
SK
Fraser
Chris H
CH
D000328:Adult; D000368:Aged; D053704:Capsule Endoscopy; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007417:Intestinal Polyps / Q000473:pathology*; D007421:Intestine, Small; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010580:Peutz-Jeghers Syndrome / Q000473:pathology*; D011159:Population Surveillance; D011446:Prospective Studies; D012042:Registries; D015203:Reproducibility of Results; D016037:Single-Blind Method; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires