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Endoscopy 2012; 44(07): 668-673
DOI: 10.1055/s-0032-1309386
Original article
© Georg Thieme Verlag KG Stuttgart · New York

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

B. M. Wiarda
1   Department of Radiology, Medical Center Alkmaar, Alkmaar, The Netherlands
,
D. G. N. Heine
2   Department of Gastroenterology, Medical Center Alkmaar, Alkmaar, The Netherlands
,
P. Mensink
3   Departments of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
,
M. Stolk
4   Department of Gastroenterology, St Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
,
J. Dees
3   Departments of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
,
H. J. A. Hazenberg
5   Department of Gastroenterology, Deventer Ziekenhuis, Deventer, The Netherlands
,
J. Stoker
6   Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
,
E. J. Kuipers
3   Departments of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
7   Internal Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
› Author Affiliations
Further Information

Publication History

submitted 25 April 2011

accepted after revision 22 February 2012

Publication Date:
23 April 2012 (online)

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Commentaire de travail de B. M. Wlarda, pp. 668Endoscopy 2012; 44(07): 718-719
DOI: 10.1055/s-0032-1309990

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.

 

  • References

  • 1 Zuckerman GR, Prakash C, Askin MP et al. A technical review on the evaluation and management of occult and obscure gastrointestinal bleeding. Gastroenterology 2000; 118: 201-221
    CrossrefPubMedGoogle Scholar
  • 2 Raju GS, Gerson L, Das A et al. American Gastroenterological Association (AGA) Institute medical position statement on obscure gastrointestinal bleeding. Gastroenterology 2007; 133: 1694-1696
    CrossrefPubMedGoogle Scholar
  • 3 Triester SL, Leighton JA, Leontiadis GI et al. A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with obscure gastrointestinal bleeding. Am J Gastroenterol 2005; 100: 2407-2418
    CrossrefPubMedGoogle Scholar
  • 4 Van Tuyl SA, Van Noorden JT, Kuipers EJ et al. Results of videocapsule endoscopy in 250 patients with suspected small bowel pathology. Dig Dis Sci 2006; 51: 900-905
    CrossrefPubMedGoogle Scholar
  • 5 Yamamoto H, Sekine Y, Sato Y et al. Total enteroscopy with a nonsurgical steerable double-balloon method. Gastrointest Endosc 2001; 53: 216-220
    Google Scholar
  • 6 May A, Nachbar L, Ell C. Double-balloon enteroscopy (push-and-pull enteroscopy) of the small bowel: feasibility and diagnostic and therapeutic yield in patients with suspected small bowel disease. Gastrointest Endosc 2005; 62: 62-70
    CrossrefPubMedGoogle Scholar
  • 7 Heine GD, Hadithi M, Groenen MJ et al. Double-balloon enteroscopy: indications, diagnostic yield, and complications in a series of 275 patients with suspected small-bowel disease. Endoscopy 2006; 38: 42-48
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Wiarda BM, Kuipers EJ, Houdijk LP et al. MR enteroclysis: imaging technique of choice in diagnosis of small bowel diseases. Dig Dis Sci 2005; 50: 1036-1040
    CrossrefPubMedGoogle Scholar
  • 9 Negaard A, Sandvik L, Mulahasanovic A et al. Magnetic resonance enteroclysis in the diagnosis of small-intestinal Crohn’s disease: diagnostic accuracy and inter- and intra-observer agreement. Acta Radiol 2006; 47: 1008-1016
    CrossrefPubMedGoogle Scholar
  • 10 Ochsenkuhn T, Herrmann K, Schoenberg SO et al. Crohn disease of the small bowel proximal to the terminal ileum: detection by MR-enteroclysis. Scand J Gastroenterol 2004; 39: 953-960
    CrossrefPubMedGoogle Scholar
  • 11 Paolantonio P, Tomei E, Rengo M et al. Adult celiac disease: MRI findings. Abdom Imaging 2007; 32: 433-440
    CrossrefPubMedGoogle Scholar
  • 12 Wiarda BM, Heine DG, Rombouts MC et al. Jejunum abnormalities at MR enteroclysis. Eur J Radiol 2008; 67: 125-132
    CrossrefPubMedGoogle Scholar
  • 13 May A, Ell C. Push-and-pull enteroscopy using the double-balloon technique/double-balloon enteroscopy. Dig Liver Dis 2006; 38: 932-938
    CrossrefPubMedGoogle Scholar
  • 14 Böcker U, Dinter D, Litterer C et al. Comparison of magnetic resonance imaging and video capsule enteroscopy in diagnosing small-bowel pathology: localization-dependent diagnostic yield. Scand J Gastroenterol 2010; 45: 490-500
    CrossrefPubMedGoogle Scholar
  • 15 Pasha SF, Leighton JA, Das A et al. Double-balloon enteroscopy and capsule endoscopy have comparable diagnostic yield in small-bowel disease: a meta-analysis. Clin Gastroenterol Hepatol 2008; 6: 671-676
    CrossrefPubMedGoogle Scholar
  • 16 Fujimori S, Seo T, Gudis K et al. Diagnosis and treatment of obscure gastrointestinal bleeding using combined capsule endoscopy and double balloon endoscopy: 1-year follow-up study. Endoscopy 2007; 39: 1053-1058
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Chen X, Ran ZH, Tong JL et al. A meta-analysis of the yield of capsule endoscopy compared to double-balloon enteroscopy in patients with small bowel diseases. World J Gastroenterol 2007; 13: 4372-4378
    CrossrefPubMedGoogle Scholar
  • 18 Pennazio M. Capsule endoscopy: where are we after 6 years of clinical use?. Dig Liver Dis 2006; 38: 867-878
    CrossrefPubMedGoogle Scholar
  • 19 Eliakim R, Arber N. Obscure gastrointestinal bleeding – are we there yet?. Digestion 2004; 70: 199-200
    CrossrefPubMedGoogle Scholar
  • 20 Cellier C. Obscure gastrointestinal bleeding: role of videocapsule and double-balloon enteroscopy. Best Pract Res Clin Gastroenterol 2008; 22: 329-340
    CrossrefPubMedGoogle Scholar
  • 21 Pennazio M. Enteroscopy and capsule endoscopy. Endoscopy 2006; 38: 1079-1086
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Ross A, Mehdizadeh S, Tokar J et al. Double balloon enteroscopy detects small bowel mass lesions missed by capsule endoscopy. Dig Dis Sci 2008; 53: 2140-2143
    CrossrefPubMedGoogle Scholar
  • 23 Iwamoto J, Mizokami Y, Shimokobe K et al. The clinical outcome of capsule endoscopy in patients with obscure gastrointestinal bleeding. Hepatogastroenterology 2011; 58: 301-305
    PubMedGoogle Scholar
  • 24 Katsinelos P, Chatzimavroudis G, Terzoudis S et al. Diagnostic yield and clinical impact of capsule endoscopy in obscure gastrointestinal bleeding during routine clinical practice: a single-center experience. Med Princ Pract 2011; 20: 60-65
    CrossrefPubMedGoogle Scholar
  • 25 Marmo R, Rotondano G, Casetti T et al. Degree of concordance between double-balloon enteroscopy and capsule endoscopy in obscure gastrointestinal bleeding: a multicenter study. Endoscopy 2009; 41: 587-592
    Article in Thieme ConnectPubMedGoogle Scholar