Diagnosis of small bowel Crohn's disease: a prospective comparison of capsule endoscopy with magnetic resonance imaging and fluoroscopic enteroclysis

Jörg G. Albert ¹, Friederike Martiny ¹, Annette Krummenerl ¹, Karsten Stock ², Joachim Leke ¹, Christa M. Göbel ¹, Erich Lotterer ¹, Hubert H Nietsch ¹, Curt Behrmann ² and Wolfgang E. Fleig ^1*

¹ First Department of Medicine, Martin-Luther-University Hospitals and Clinics, Germany
² Department of Radiology, Martin-Luther-University Hospitals and Clinics, Germany

^* To whom correspondence should be addressed. E-mail: wolfgang.fleig{at}medizin.uni-halle.de.

Accepted 27 June 2005

Abstract

Background & Aims: The diagnostic yield of capsule endoscopy (CE) as compared to magnetic resonance imaging (MRI) in small bowel Crohn's disease is not well- established. We prospectively investigated CE, MRI, and double-contrast fluoroscopy in patients with suspected small bowel Crohn's disease.

Methods: 52 consecutive patients (39 female, 13 male) were investigated by MRI, fluoroscopy and - if bowel obstruction could be excluded - by CE. In 25, Crohn's disease was newly suspected, while the diagnosis of Crohn's disease (non small bowel) had been previously established in 27.

Results: Small bowel Crohn's disease was diagnosed in 41 out of 52 patients (79%). CE was not accomplished in 14 patients due to bowel strictures. Of the remaining 27 patients, CE, MRI, and fluoroscopy detected small bowel Crohn's disease in 25 (93%), 21 (78%), and 7 (of 21; 33%) cases, respectively. CE was the only diagnostic tool in four patients. CE was slightly more sensitive than MRI (12 vs. 10 of 13 in suspected Crohn's disease and 13 vs. 11 of 14 in established Crohn's disease). MRI detected inflammatory conglomerates and enteric fistulae in 3 and 2 cases, respectively.

Conclusion: CE and MRI are complementary means in diagnosing small bowel Crohn's disease. CE is capable of detecting limited mucosal lesions that may be missed by MRI, but awareness of bowel obstruction is mandatory. In contrast, MRI is helpful to identify transmural Crohn's disease and extra-luminal lesions, and may exclude strictures.

Keywords: Crohn's disease, capsule endoscopy, digestive system endoscopy, inflammatory bowel disease, small bowel endoscopy

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