title: Small bowel enteroclysis with magnetic resonance imaging and computed tomography in patients with failed and uncertain passage of a patency capsule.
abstract: BACKGROUND
  Video capsule enteroscopy (VCE) has revolutionized small bowel imaging, enabling visual examination of the mucosa of the entire small bowel, while MR enteroclysis (MRE) and CT enteroclysis (CTE) have largely replaced conventional barium enteroclysis. A new indication for MRE and CTE is the clinical suspicion of small bowel strictures, as indicated by delayed or non-delivery of a test capsule given before a VCE examination, to exclude stenosis. The aim of this study was to determine the clinical value of subsequent MRE and CTE in patients in whom a test capsule did not present itself in due time.
  
  
  METHODS
  Seventy-five consecutive patients were identified with a delayed or unnoticed delivery of the test capsule. Seventy patients consented to participate and underwent MRE (44) or CTE (26). The medical records and imaging studies were retrospectively reviewed and symptoms, laboratory results and imaging findings recorded.
  
  
  RESULTS
  Lesions compatible with Crohns disease were shown by MRE in 5 patients, by CTE in one and by VCE in four, one of whom had lesions on MRE. In patients without alarm symptoms and findings (weight loss, haematochezia, anaemia, nocturnal diarrheoa, ileus, fistula, abscess and abnormal blood tests) imaging studies did not unveil any such lesion. VCE's were performed in only 20 patients, mainly younger than 50 years of age, although no stenotic lesion was shown by MRE and CTE. In the remaining 50 patients no VCE or other endoscopic intervention was performed indicating that the referring physician was content with the diagnostic information from MRE or CTE.
  
  
  CONCLUSIONS
  The diagnostic value of MRE and CTE is sufficient for clinical management of most patients with suspected small bowel disease, and thus VCE may be omitted or at least postponed for later usage.
authors.affiliation: Department of Clinical Sciences Malmö, Medical Radiology, Diagnostic Centre of Imaging and Functional Medicine, Skåne University Hospital, SE-20502 Malmö, Sweden. thomas.fork@med.lu.se
authors.forename: Frans-Thomas
authors.initials: FT
authors.lastname: Fork
authors.forename: Nils
authors.initials: N
authors.lastname: Karlsson
authors.forename: Sattar
authors.initials: S
authors.lastname: Kadhem
authors.forename: Bodil
authors.initials: B
authors.lastname: Ohlsson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D053704:Capsule Endoscopy; D002214:Capsules; D002648:Child; D003287:Contrast Media; D003424:Crohn Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005260:Female; D005682:Gadolinium; D006571:Heterocyclic Compounds; D006801:Humans; D007421:Intestine, Small / Q000000981:diagnostic imaging / Q000473:pathology*; D007472:Iohexol; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds; D011092:Polyethylene Glycols / Q000008:administration & dosage; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D002214:Capsules; D003287:Contrast Media; D006571:Heterocyclic Compounds; D009942:Organometallic Compounds; D011092:Polyethylene Glycols; D007472:Iohexol; C050823:gadolinium 1,4,7,10-tetraazacyclododecane-N,N',N'',N'''-tetraacetate; D005682:Gadolinium