Magnetic resonance enterography, small-intestine contrast US, and capsule endoscopy to evaluate the small bowel in pediatric Crohn's disease: A prospective, blinded, comparison study

Background Small-bowel (SB) disease is a severe clinical entity among the phenotypes of Crohn's disease (CD). Objective To assess sensitivity, specificity, and accuracy of magnetic resonance enterography (MRE), small-intestine contrast US (SICUS), and capsule endoscopy (CE) in the diagnosis of pediatric SB-CD. Design Prospective, blinded, comparison study. Setting Tertiary center for pediatric inflammatory bowel disease. Patients Children with known or suspected CD. Diagnosis of SB obstruction at SICUS or MRE excluded patients from the study. Intervention Patients underwent ileocolonoscopy, MRE, SICUS, and CE over a 7-day period. For the imaging evaluation, SB was divided into 3 segments: jejunum, proximal and mid ileum, and terminal ileum. Main Outcome Measurements The performance of each method was compared to a consensus reference standard for upper SB and to ileocolonoscopy for the terminal ileum. Results Twenty-five patients completed the study. In the jejunum, the sensitivity of SICUS and CE was 92%, which was not significantly higher than MRE (75%); the specificity of CE (61%) was significantly lower than that of MRE ( P = .04). In the proximal and mid ileum, MRE and CE did not have significantly higher sensitivity (100%) than SICUS (80%), but CE was less specific ( P > .05). At the terminal ileum, SICUS and MRE were slightly more sensitive than CE (94% vs. 81%); however, the latter was more specific. Limitations Use of the consensus reference standard for upper SB. Small number of patients. Conclusion SICUS, MRE, and CE are all effective options for imaging SB. An integrated use of different tools should be suggested to achieve a complete assessment of the SB in children with suspected or confirmed CD.