Small-bowel imaging in Crohn's disease: a prospective, blinded, 4 ...

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Small-bowel imaging in Crohn’s diseaseSolem et alFigure 2. A, B, C, Computed tomography enterography in a 43-year-old woman with Crohn’s disease, depicting asymptomatic PSBO due to multiplesegments of actively inflamed jejunum, precluding ingestion of endoscopy capsule. Axial and 2D multiplanar reformatted images depict both luminalnarrowing caused by active inflammation (with segmental hyperenhancement mural stratification, arrows) and prestenotic bowel dilation(arrowheads).in 56 patients with known Crohn’s disease. 27 CTE was performedprior to CE, and 27% of patients were precludedfrom CE because of strictures. 27 They used stricter criteriafor excluding patients from CE (ie, stricture !1-cm luminal diameter with no proximal SB dilation required),but still experienced one episode of capsuleretention (2%) requiring removal from the jejunum withpush enteroscopy, and one episode of symptomaticPSBO requiring high-dose corticosteroid therapy beforespontaneous passage.Our results are somewhat at variance with other studiescomparing CE and CTE in patients with known or suspectedCrohn’s disease. 22,27,29 A meta-analysis of these 3studies suggested that the prevalence of abnormalities detectedon CE was 38% higher than that of CTE. 41 However,this value was significantly higher than CTE only for thesubgroup of patients with known Crohn’s disease. We believethe differences in study results are due to a numberof factors. In one of these studies, 22 the enteric contrastused apparently was a positive agent (30% Telebrix), not262 GASTROINTESTINAL ENDOSCOPY Volume 68, No. 2 : 2008 www.giejournal.org
Solem et alSmall-bowel imaging in Crohn’s diseaseFigure 3. A, B, C, D, SB ulceration and stenosis in the patient who experienced a highly symptomatic PSBO shortly after capsule ingestion, resulting inhospitalization for several days. E, CTE demonstrated approximately 50 cm of actively inflamed ileum with mural enhancement and stratification (arrows),but without any proximal SB dilation (arrowhead). The symptoms resolved and the capsule eventually passed after steroid and infliximabtreatment.a negative/neutral contrast agent, as used in our study. Useof a positive contrast would diminish the operating characteristicsof CTE, as it would not take advantage of thedifferences in attenuation between the bowel lumen andbowel wall. Furthermore, our study was the only one ofthese that met both of the following criteria: there existeda range of diagnostic uncertainty (recruitment of bothknown and suspected Crohn’s), and the readers of eachwww.giejournal.org Volume 68, No. 2 : 2008 GASTROINTESTINAL ENDOSCOPY 263
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Small-bowel imaging in Crohn's disease: a prospective, blinded, 4 ...

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