Capsule endoscopy bests MRE in detecting proximal small bowel Crohn’s

CHICAGO — While capsule endoscopy, magnetic resonance enterography and small bowel intestinal contrast ultrasound resulted in comparable diagnostic yield for detection of small bowel Crohn’s disease, capsule endoscopy was superior to MRE for detecting proximal disease, according to research presented at Digestive Disease Week.

A meta-analysis published 7 years ago in the American Journal of Gastroenterology demonstrated that capsule endoscopy was better than CT enterography and ileocolonoscopy, and had a similar yield to that of MRE, but since then additional studies have been performed and new diagnostic methodologies have emerged, Uri Kopylov, MD, of the department of gastroenterology at Sheba Medical Center in Israel, said during his presentation.

He and colleagues therefore performed an updated systematic review and meta-analysis, searching for prospective trials comparing capsule endoscopy with MRE or small bowel intestinal contrast ultrasound (SICUS).

They ultimately included 13 European studies with 500 patients in their analysis, three of which included pediatric patients only. They found that all three methodologies showed similar diagnostic yields in the overall study population. The odds ratio for capsule endoscopy vs. MRE was 0.56 (95% CI, 0.28-1.13) and for capsule endoscopy vs. SICUS it was 0.85 (95% CI, 0.69-1.38).

Kopylov noted that diagnostic yields were comparable between patients with suspected vs. established Crohn’s disease and pediatric vs. adult patients. Further, the diagnostic yields were comparable for detecting distal small bowel disease.

“Interestingly, in proximal small bowel disease, there was a significant advantage for capsule endoscopy vs. MRE and also there was a numerical difference in favor of capsule endoscopy vs. intestinal ultrasound but the results didn’t quite reach statistical significance,” Kopylov said.

The OR for capsule endoscopy vs. MRE for detecting proximal small bowel disease was 2.62 (95% CI, 1.1-6.53).

“This has a potential advantage for prognostic and, in the future, maybe even therapeutic considerations,” Kopylov said. “However, this advantage should be weighed against the risk of retention. If we just address the results from this analysis there were three cases of capsule endoscopy retentions, which comes out to 0.6%.” – by Adam Leitenberger

Reference:

Kopylov U, et al. Abstract 117. Presented at: Digestive Disease Week; May 6-9, 2017; Chicago.

Disclosures: Kopylov reports financial relationships with Takeda, Janssen, AbbVie, Medtronic and CTS.