Abstract
Background and aims
Small bowel MR enteroclysis and wireless capsule endoscopy (WCE) are new diagnostic tools for the investigation of the small bowel. The aim of this study was to compare the diagnostic yield of WCE with MR enteroclysis in the detection of small bowel pathologies.
Methods
A total of 36 patients were included in the study. Indications for imaging of the small bowel were proven or suspected small bowel Crohn’s disease (CD; n=18), obscure gastrointestinal (GI) bleeding (n=14) and tumour surveillance (n=4).
Results
In patients with Crohn’s disease WCE detected significantly more inflammatory lesions in the first two segments of the small bowel compared with MR enteroclysis (12 patients vs. 1 patient, p=0.016). In 5 out of 14 (36%) patients with GI bleeding, angiodysplasia was detected as a possible bleeding source. Three of these patients had active bleeding sites detected by WCE. One patient had scattered inflammation of the mucosa. MR enteroclysis did not reveal any intestinal abnormalities in this patient group. MR enteroclysis provided extraintestinal pathologies in 10 out of 36 (28%) patients.
Conclusion
In patients with Crohn’s disease WCE revealed significantly more inflammatory lesions in the proximal and middle part of the small bowel in comparison to MR enteroclysis, whereas in patients with obscure GI bleeding WCE was superior to MR enteroclysis.
Similar content being viewed by others
References
Sellink JL (1974) Radiologic examination of the small intestine by duodenal intubation. Acta Radiol Diagn (Stockh) 15:318–332
Ott DJ, Chen YM, Gelfand DW, Van Swearingen F, Munitz HA (1985) Detailed per-oral small bowel examination vs. enteroclysis. II. Radiographic accuracy. Radiology 155:31–34
Schreyer AG, Geissler A, Albrich H, Scholmerich J, Feuerbach S, Rogler G, Volk M, Herfarth H (2004) Abdominal MRI after enteroclysis or with oral contrast in patients with suspected or proven Crohn’s disease. Clin Gastroenterol Hepatol 2:491–497
Rieber A, Wruk D, Potthast S, Nussle K, Reinshagen M, Adler G, Brambs HJ (2000) Diagnostic imaging in Crohn’s disease: comparison of magnetic resonance imaging and conventional imaging methods. Int J Colorectal Dis 15:176–181
Turetschek K, Schober E, Wunderbaldinger P, Bernhard C, Schima W, Puespoek A, Vogelsang H, Moeschl P, Mostbeck G (2002) Findings at helical CT-enteroclysis in symptomatic patients with Crohn disease: correlation with endoscopic and surgical findings. J Comput Assist Tomogr 26:488–492
Hassan C, Cerro P, Zullo A, Spina C, Morini S (2003) Computed tomography enteroclysis in comparison with ileoscopy in patients with Crohn’s disease. Int J Colorectal Dis 18:121–125
Iddan G, Meron G, Glukhovsky A, Swain P (2000) Wireless capsule endoscopy. Nature 405:417
Appleyard M, Fireman Z, Glukhovsky A, Jacob H, Shreiver R, Kadirkamanathan S, Lavy A, Lewkowicz S, Scapa E, Shofti R, Swain P, Zaretsky A (2000) A randomized trial comparing wireless capsule endoscopy with push enteroscopy for the detection of small-bowel lesions. Gastroenterology 119:1431–1438
Costamagna G, Shah SK, Riccioni ME, Foschia F, Mutignani M, Perri V, Vecchioli A, Brizi MG, Picciocchi A, Marano P (2002) A prospective trial comparing small bowel radiographs and video capsule endoscopy for suspected small bowel disease. Gastroenterology 123:999–1005
Eliakim R, Fischer D, Suissa A, Yassin K, Katz D, Guttman N, Migdal M (2003) Wireless capsule video endoscopy is a superior diagnostic tool in comparison to barium follow-through and computerized tomography in patients with suspected Crohn’s disease. Eur J Gastroenterol Hepatol 15:363–367
Fireman Z, Mahajna E, Broide E, Shapiro M, Fich L, Sternberg A, Kopelman Y, Scapa E (2003) Diagnosing small bowel Crohn’s disease with wireless capsule endoscopy. Gut 52:390–392
Mow WS, Lo SK, Targan SR, Dubinsky MC, Treyzon L, Abreu-Martin MT, Papadakis KA, Vasiliauskas EA, Voderholzer WA, Ortner M, Rogalla P, Beinholzl J, Lochs H (2004) Initial experience with wireless capsule enteroscopy in the diagnosis and management of inflammatory bowel disease. Diagnostic yield of wireless capsule enteroscopy in comparison with computed tomography enteroclysis. Clin Gastroenterol Hepatol 2:31–40
Voderholzer WA, Ortner M, Rogalla P, Beinholzl J, Lochs H (2003) Diagnostic yield of wireless capsule enteroscopy in comparison with computed tomography enteroclysis. Endoscopy 35:1009–1014
Ell C, Remke S, May A, Helou L, Henrich R, Mayer G (2002) The first prospective controlled trial comparing wireless capsule endoscopy with push enteroscopy in chronic gastrointestinal bleeding. Endoscopy 34:685–689
Liangpunsakul S, Chadalawada V, Rex DK, Maglinte D, Lappas J (2003) Wireless capsule endoscopy detects small bowel ulcers in patients with normal results from state of the art enteroclysis. Am J Gastroenterol 98:1295–1298
Rieber A, Aschoff A, Nussle K, Wruk D, Tomczak R, Reinshagen M, Adler G, Brambs HJ (2000) MRI in the diagnosis of small bowel disease: use of positive and negative oral contrast media in combination with enteroclysis. Eur Radiol 10:1377–1382
Hilfiker PR, Weishaupt D, Kacl GM, Hetzer FH, Griff MD, Ruehm SG, Debatin JF (1999) Comparison of three dimensional magnetic resonance imaging in conjunction with a blood pool contrast agent and nuclear scintigraphy for the detection of experimentally induced gastrointestinal bleeding. Gut 45:581–587
Schreyer AG, Golder S, Seitz J, Herfarth H (2003) New diagnostic avenues in inflammatory bowel diseases. Capsule endoscopy, magnetic resonance imaging and virtual enteroscopy. Dig Dis 21:129–137
De Mascarenhas-Saraiva MN, da Silva Araujo Lopes LM (2003) Small-bowel tumors diagnosed by wireless capsule endoscopy: report of five cases. Endoscopy 35:865–868
Schulmann K, Schmiegel W (2004) Capsule endoscopy for small bowel surveillance in hereditary intestinal polyposis and non-polyposis syndromes. Gastrointest Endosc Clin N Am 14:149–158
Barkay O, Alon-Baron L, Shemesh E, Arber N, Costamagna G, Shah SK, Riccioni ME, Foschia F, Mutignani M, Perri V, Vecchioli A, Brizi MG, Picciocchi A, Marano P (2004) Endoscopically assisted wireless capsule endoscopy in a patient with familial adenomatous polyposis after total proctocolectomy and continent ileostomy: a prospective trial comparing small bowel radiographs and video capsule endoscopy for suspected small bowel disease. Isr Med Assoc J 6:251–252
Wold PB, Fletcher JG, Johnson CD, Sandborn WJ (2003) Assessment of small bowel Crohn disease: noninvasive peroral CT enterography compared with other imaging methods and endoscopy—feasibility study. Radiology 229:275–281
Lo SK (2004) Capsule endoscopy in the diagnosis and management of inflammatory bowel disease. Gastrointest Endosc Clin N Am 14:179–193
Hanauer SB, Stromberg U (2004) Oral pentasa in the treatment of active Crohn’s disease: a meta-analysis of double-blind, placebo-controlled trials. Clin Gastroenterol Hepatol 2:379–388
Feagan BG (2004) 5-ASA therapy for active Crohn’s disease: old friends, old data, and a new conclusion. Clin Gastroenterol Hepatol 2:376–378
Herfarth H, Gross V, Andus T, Caesar I, Vogelsang H, Adler G, Malchow H, Petri A, Gierend M, Scholmerich J (2003) Analysis of the therapeutic efficacy of different doses of budesonide in patients with active Crohn’s ileocolitis depending on disease activity and localization. Int J Colorectal Dis 19:147–152
Sandborn WJ, Feagan BG (2003) Review article: mild to moderate Crohn’s disease—defining the basis for a new treatment algorithm. Aliment Pharmacol Ther 18:263–277
Modigliani R (1990) Endoscopic severity index for Crohn’s disease. Gastrointest Endosc 36:637
Modigliani R, Mary JY, Simon JF, Cortot A, Soule JC, Gendre JP, Rene E (1990) Clinical, biological, and endoscopic picture of attacks of Crohn’s disease. Evolution on prednisolone. Groupe d’Etude Therapeutique des Affections Inflammatoires Digestives. Gastroenterology 98:811–818
McLeod RS, Wolff BG, Steinhart AH, Carryer PW, O’Rourke K, Andrews DF, Blair JE, Cangemi JR, Cohen Z, Cullen JB, Chaytor RG, Greenberg GR, Jaffer NM, Jeejeebhoy KN, MacCarty RL, Ready RL, Weiland LH (1997) Risk and significance of endoscopic/radiological evidence of recurrent Crohn’s disease. Gastroenterology 113:1823–1827
Rutgeerts P (2003) Modern therapy for inflammatory bowel disease. Scand J Gastroenterol Suppl (237):30–33?
Zuckerman GR, Prakash C, Askin MP, Lewis BS (2000) AGA technical review on the evaluation and management of occult and obscure gastrointestinal bleeding. Gastroenterology 118:201–221
Chan FP, Chhor CM (2003) Active lower gastrointestinal hemorrhage diagnosed by magnetic resonance angiography: case report. Abdom Imaging 28:637–639
Anderson CM (2002) GI magnetic resonance angiography. Gastrointest Endosc 55:S42–S48
Rossini FP, Risio M, Pennazio M (1999) Small bowel tumors and polyposis syndromes. Gastrointest Endosc Clin N Am 9:93–114
Maglinte DDT, Siegelman ES, Kelvin FM (2000) MR enteroclysis: the future of small-bowel imaging? Radiology 215:639–641
Bender GN, Maglinte DD, Kloppel VR, Timmons JH (1999) CT enteroclysis: a superfluous diagnostic procedure or valuable when investigating small-bowel disease? Am J Roentgenol 172:373–378
De Franco A, Celi G, Restaino G, Foschi R, Vecchioli A, Marano P, Papanikolaou N, Prassopoulos P, Grammatikakis I, Maris T, Gourtsoyiannis NC, Rieber A, Aschoff A, Nussle K, Wruk D, Tomczak R, Reinshagen M, Adler G, Brambs HJ (2002) Imaging of small bowel tumors: technical challenges and clinical applications of magnetic resonance enteroclysis in the diagnosis of small bowel disease: use of positive and negative oral contrast media in combination with enteroclysis. Rays 27:35–50
Bader TR, Semelka RC, Chiu VC, Armao DM, Woosley JT (2001) MRI of carcinoid tumors: spectrum of appearances in the gastrointestinal tract and liver. J Magn Reson Imaging 14:261–269
Horton KM, Kamel I, Hofmann L, Fishman EK (2004) Carcinoid tumors of the small bowel: a multitechnique imaging approach. Am J Roentgenol 182:559–567
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gölder, S.K., Schreyer, A.G., Endlicher, E. et al. Comparison of capsule endoscopy and magnetic resonance (MR) enteroclysis in suspected small bowel disease. Int J Colorectal Dis 21, 97–104 (2006). https://doi.org/10.1007/s00384-005-0755-0
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00384-005-0755-0