[The diagnosis of Crohn's disease of the small bowel: comparing CT enterography, capsule endoscopy, small-bowel follow through and ileocolonoscopy]

Abstract

Objective: To investigate the diagnostic value of capsule endoscopy (CE), CT enterography (CTE), ileocolonoscopy and small bowel follow through (SBFT) for small bowel Crohn's disease (CD).

Methods: Fifty-seven consecutive patients with CD underwent ileocolonoscopy, CTE, CE, and SBFT. It included the presence of the following symptoms and signs: abdominal pain, weight loss, diarrhea, fever and positive fecal occult blood test. The location and the characteristics of intestinal and extra-intestinal lesions detected by four techniques were compared. The proportions of patients with positive findings using each examination were compared.

Results: Of the 57 patients, 50 underwent ileocolonoscopy, terminal ileum lesion was found in 33 patients (66.00%), the remaining 17 (34.0%) were normal; among 34 patients who had CTE, 29 of small bowel lesion were found (85.29%); CE were performed in 27 patients, due to prolonged gastric transit one time, the capsule did not reach the cecum in one patient during battery lifetime. CE showed small bowel lesion in 26 patients (96.30%); SBFT was performed in 39 patients and 26 of small bowel lesion were detected (66.67%). CE had the highest diagnostic yield for CD and ileocolonoscopy had the lowest, and there were statistically significant difference among the 4 examinations (P = 0.006). The combined positive rates of two methods were: CE + CTE 92.86% (13/14), SBFT + CTE 90.91% (20/22), CE + ileocolonoscopy 95.65% (22/23), CE + SBFT 100% (17/17), ileocolonoscopy + CTE 89.66% (26/29), ileocolonoscopy + SBFT 77.78% (28/36), but there were no significant differences between each two examinations.

Conclusion: CE, CTE have a higher yield in depicting mild to moderate finding of CD than SBFT. CE is better for assessing early mucosal disease, whereas CTE is better for detecting transmural and extraluminal abnormalities. Most important, CE plus CTE may depict nonobstructive CD of the small bowel when conventional techniques such as ileocolonoscopy or SBFT have negative or inconclusive finding. CE provides us explanations for the symptoms of patients, decision to follow up or therapy.