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P109. Diagnostic value of magnetic resonance enterography compared with capsule endoscopy in small-bowel mucosal lesions in patients with suspected or established non-obstructive Crohn's disease: A meta-analysis

G. Nalmpantidis, T. Maris, H. Taloumtzis, A. Gantos, G. Kitis

G. Papanikolaou General Hospital, Thessaloniki, Greece

Aim: Magnetic Resonance Enterography (MRE) has demonstrated high performance compared with Capsule Endoscopy in detecting Small-Bowel (SB) mucosal lesions in patients with suspected or proven non-obstructive Crohn's disease (CD). The aim of this meta-analysis was to identify the diagnostic value of MRE in SB mucosal lesions, compared with CE, in this patient group.

Materials and Methods: Databases of MEDLINE, EMBASE and Cochrane were screened up to October 2010 using highly sensitive search strategies. Data of each study were extracted, analyzed and pooled, separately for patients with suspected and proven non-obstructive CD. Sensitivity (Se), specificity (Sp), positive and negative likelihood ratio (+LR, −LR), diagnostic Odds ratio (OR) and Area Under the Curve (AUC) were calculated using MetaDisc 1.4 and NCSS 2007 software (random effects model). Heterogeneity was assessed with I2.

Results: Five studies (n = 99 patients) met the inclusion criteria and contributed in, at least one, group data synthesis. In all studies the GIVEN wireless capsule were used. In patients with suspected CD the diagnostic value was: Se=0.69 (0.49–0.85), Sp = 0.84 (0.64–0.95), +LR = 3.35 (1.35–8.3), −LR = 0.49 (0.28–0.83), OR = 10.15 (2.49–41.45) and AUC = 0.84 (SEAUC = 0.08). In patients with established CD the diagnostic value was: Se = 0.82 (0.68–0.92), Sp = 0.57 (0.18–0.90), +LR = 1.45 (0.72–2.92), −LR = 0.37 (0.16–0.84), OR = 5.6 (0.9–34.43) and AUC = 0.77 (SEAUC = 0.14). Heterogeneity was greater in the case of Se data. No risk difference in the proportions of procedure related events were noted (risk difference = 0.015, 95% confidence intervals −0.046 to 0.077, P = 0.794).

Conclusions: Our study quantified the diagnostic value of MRE in detecting SB mucosal lesions in patients with suspected or proven non-obstructive CD. Although no gold standard method exists for diagnosing SB CD, MRE is of high diagnostic performance compared with CE in identifying SB mucosal lesions, especially in patients with suspected CD. Given its lower cost and the extraluminal diagnostic information that it can give, MRE may serve as a first-line modality in diagnosing mucosal lesions in patients with suspected or proven CD.