Comparison of magnetic resonance enteroclysis and capsule endoscopy with balloon-assisted enteroscopy in patients with obscure gastrointestinal bleeding

B. M. Wiarda; D. G. N. Heine; P. Mensink; M. Stolk; J. Dees; H. J. A. Hazenberg; J. Stoker; E. J. Kuipers

doi:10.1055/s-0032-1309386

Endoscopy, Table of Contents

Endoscopy 2012; 44(07): 668-673
DOI: 10.1055/s-0032-1309386

Original article

Comparison of magnetic resonance enteroclysis and capsule endoscopy with balloon-assisted enteroscopy in patients with obscure gastrointestinal bleeding

B. M. Wiarda

¹Department of Radiology, Medical Center Alkmaar, Alkmaar, The Netherlands

,

D. G. N. Heine

²Department of Gastroenterology, Medical Center Alkmaar, Alkmaar, The Netherlands

,

P. Mensink

³Departments of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands

,

M. Stolk

⁴Department of Gastroenterology, St Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands

,

J. Dees

³Departments of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands

,

H. J. A. Hazenberg

⁵Department of Gastroenterology, Deventer Ziekenhuis, Deventer, The Netherlands

,

J. Stoker

⁶Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands

,

E. J. Kuipers

³Departments of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands

⁷Internal Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands

› Author Affiliations

Abstract

Background and study aims: New modalities are available for visualization of the small bowel in patients with possible obscure gastrointestinal bleeding (OGIB), but their performance requires further comparison. This study compared the diagnostic yield of magnetic resonance enteroclysis (MRE) and capsule endoscopy in patients with OGIB, using balloon-assisted enteroscopy (BAE) as the reference standard.

Patients and methods: Consecutive consenting patients who were referred for evaluation of OGIB were prospectively included. Patients underwent MRE followed by capsule endoscopy and BAE. Patients with high grade stenosis at MRE did not undergo capsule endoscopy. The reference standard was BAE findings in visualized small-bowel segments and expert panel consensus for segments not visualized during BAE.

Results: Over a period of 26 months, 38 patients were included (20 female [53 %]; mean age 58 years, range 28 – 75 years). Four patients (11 %) did not undergo capsule endoscopy due to high grade small-bowel stenosis at MRE (n = 3; 8 %) or timing issues (n = 1; 3 %). Capsule endoscopy was non-diagnostic in one patient. The reference standard identified abnormal findings in 20 patients (53 %). MRE had sensitivity, specificity, and positive and negative likelihood ratios of 21 %, 100 %, infinity, and 0.79, respectively. The corresponding values for capsule endoscopy were 61 %, 85 %, 4.1, and 0.46. The reference standard and capsule endoscopy did not differ in percent positive findings (P = 0.34), but MRE differed significantly from the reference BAE (P < 0.001). Capsule endoscopy was superior to MRE for detecting abnormalities (P = 0.0015).

Conclusion: Capsule endoscopy performed better than MRE in the detection of small-bowel abnormality in patients with OGIB. MRE may be considered as an alternative for the initial examination in patients with clinical suspicion of small-bowel stenosis.

Full Text

References

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