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.