Computed tomography enterography versus balloon-assisted enteroscopy for evaluation of small bowel lesions in Crohn's disease

Background and Aim We aimed to assess the correlation between computed tomography enterography (CTE) and balloon-assisted enteroscopy on severity of small bowel lesions, and evaluated the accuracy of CTE parameters in assessing small intestine lesions in patients with Crohn's disease (CD). Methods We performed an observational study of a single-center cohort. Data were retrieved from our inpatient databases starting from October 2007. Correlations between computed tomography parameters (bowel wall thickness, mural enhancement, comb sign, extramural findings, and stricture), endoscopic and histological severity scores, CD Activity Index [CDAI], and C-reactive protein were assessed using Spearman's rank correlation. Results Seventy patients were included in this study. One hundred fifty-seven segments were examined. Bowel wall thickness (r=0.6334, P<0.0001), mural enhancement (r=0.5477, P<0.0001), comb sign (r=0.5898, P<0.0001), and extramural findings (r=0.4754, P<0.0001) were moderately correlated with the segmental Capsule Endoscopy CDAI. The segmental CTE score also moderately correlated with the segmental Capsule Endoscopy CDAI (r=0.6714, P<0.0001), while the total CTE score strongly correlated with the total Capsule Endoscopy CDAI (r=0.7252, P<0.0001). Both total CTE score (r=0.5937, P<0.0001) and total Capsule Endoscopy CDAI (r=0.6364, P<0.0001) correlated significantly with the Harvey-Bradshaw Index. Of five computed tomography parameters, bowel wall thickness have the best accuracy to detect small intestine lesions with an area under the receiver operating characteristic curve of 0.811 (P<0.0001), with a sensitivity and specificity of 81.82% and 74.14%, respectively. Conclusion CTE is a reliable technique for detecting small intestine lesions in patients with CD, also provides accurate information on small bowel CD severity and activity, with close agreement to inflammatory markers, CDAI, and histopathology.