title: Patient burden and patient preference: comparing magnetic resonance enteroclysis, capsule endoscopy and balloon-assisted enteroscopy.
abstract: OBJECTIVE
  We aimed to prospectively determine patient burden and patient preference for magnetic resonance enteroclysis, capsule endoscopy and balloon-assisted enteroscopy in patients with suspected or known Crohn's disease (CD) or occult gastrointestinal bleeding (OGIB).
  
  
  METHODS
  Consecutive consenting patients with CD or OGIB underwent magnetic resonance enteroclysis, capsule endoscopy and balloon-assisted enteroscopy. Capsule endoscopy was only performed if magnetic resonance enteroclysis showed no high-grade small bowel stenosis. Patient preference and burden was evaluated by means of standardized questionnaires at five moments in time.
  
  
  RESULTS
  From January 2007 until March 2009, 76 patients were included (M/F 31/45; mean age 46.9 years; range 20.0-78.4 years): 38 patients with OGIB and 38 with suspected or known CD. Seventeen patients did not undergo capsule endoscopy because of high-grade stenosis. Ninety-five percent (344/363) of the questionnaires were suitable for evaluation. Capsule endoscopy was significantly favored over magnetic resonance enteroclysis and balloon-assisted enteroscopy with respect to bowel preparation, swallowing of the capsule (compared to insertion of the tube/scope), burden of the entire examination, duration and accordance with the pre-study information. Capsule endoscopy and magnetic resonance enteroclysis were significantly preferred over balloon-assisted enteroscopy for clarity of explanation of the examination, and magnetic resonance enteroclysis was significantly preferred over balloon-assisted enteroscopy for bowel preparation, painfulness and burden of the entire examination. Balloon-assisted enteroscopy was significantly favored over magnetic resonance enteroclysis for insertion of the scope and procedure duration. Pre- and post-study the order of preference was capsule endoscopy, magnetic resonance enteroclysis and balloon-assisted enteroscopy.
  
  
  CONCLUSIONS
  Capsule endoscopy was preferred to magnetic resonance enteroclysis and balloon-assisted enteroscopy; it also had the lowest burden. Magnetic resonance enteroclysis was preferred over balloon-assisted enteroscopy for clarity of explanation of the examination, bowel preparation, painfulness and burden of the entire examination, and balloon-assisted enteroscopy over magnetic resonance enteroclysis for scope insertion and study duration.
authors: Department of Radiology, Medical Center Alkmaar, Alkmaar, The Netherlands. b.m.wiarda@mca.nl
authors: Bart M
authors: BM
authors: Wiarda
authors: Mark
authors: M
authors: Stolk
authors: Dimitri G N
authors: DG
authors: Heine
authors: Peter
authors: P
authors: Mensink
authors: Mai E
authors: ME
authors: Thieme
authors: Ernst J
authors: EJ
authors: Kuipers
authors: Jaap
authors: J
authors: Stoker
mesh_terms: D000328:Adult; D000368:Aged; D053704:Capsule Endoscopy / Q000523:psychology*; D017281:Cost of Illness; D003424:Crohn Disease / Q000175:diagnosis* / Q000523:psychology; D058582:Double-Balloon Enteroscopy / Q000523:psychology*; D004378:Duodenal Diseases / Q000150:complications / Q000175:diagnosis / Q000523:psychology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000523:psychology; D006801:Humans; D007579:Jejunal Diseases / Q000150:complications / Q000175:diagnosis / Q000523:psychology; D008279:Magnetic Resonance Imaging / Q000379:methods / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D057240:Patient Preference / Q000706:statistics & numerical data*; D011446:Prospective Studies; D057566:Self Report