P188 Diagnostic yield of MR enterography versus Wireless Video Capsule Endoscopy in suspected small bowel paediatric Crohn's disease
S. Subramaniam*1, J. Makanyanga1, L. Whitley1, C. Murray1, 2, N. Shah3, T. Watson4, S. McCartney1, F. Kiparissi1, 3
1University College London Hospitals NHS Foundation Trust, Department of Gastroenterology, London, United Kingdom, 2Royal Free London NHS Foundation Trust, Department of Gastroenterology, London, United Kingdom, 3Great Ormond Street Hospital, Paediatric Gastroenterology, London, United Kingdom, 4Great Ormond Street Hospital, Paediatric Radiology, London, United Kingdom
MR enterography (MRE) and wireless video capsule endoscopy (VCE) are both used as diagnostic tools in the evaluation of small bowel paediatric Crohn's disease (pCD). Both are safe, well tolerated, avoid the use of radiation and have minimal adverse consequences. The aim of this study was to assess the diagnostic yield of MRE versus VCE in pCD and to establish any differences between findings.
This was a retrospective, observational study based at a tertiary centre. Results of a paediatric database of patients with known or suspected pCD who had both MRE and VCE within 12 months were collated. A total of 41 patients were identified as having had both tests. Information on age, gender, symptoms, diagnosis and relevant findings on MRE and VCE were collected from electronic patient records.
41 patients were included in this study; 21 female and 20 male. The median age of the patients was 14 years (age range 6 to 21 years). 16/41 patients (39%) had both a normal MRE and VCE, while 11/41 (26.8%) had similarly abnormal findings (small bowel ulceration and inflammation) in a distribution that matched both on MRE and VCE.
In the remainder 14 patients (34.2%) there was a difference in the findings reported on MRE when compared to VCE particularly when disease distribution was considered. 7 of the 14 patients (50%) had a normal VCE but early terminal ileitis noted on MRE. Conversely, 2 (14.3%) patients had a normal MRE though proximal small bowel ulceration was reported on VCE. 4 (28.6%) patients had diffuse small bowel ulceration on VCE but MRE revealed just limited ileal disease. Finally, 1 (7.1%) patient had limited ileal ulceration on VCE but more extensive ileal and jejunal inflammation on MRE.
Extraluminal pathology was detected in 3/41 patients through MRE (2 with sacroileitis, 1 with ascites).
One third of patients undergoing both MRE and VCE had differences in the abnormalities and distribution of small bowel disease. MRE seemed a more sensitive tool for detecting early terminal ileitis while proximal small bowel disease may be more frequently identified through VCE. The use of both modalities in combination will significantly improve the identification of abnormalities in diagnosing small bowel Crohn's disease and help in treatment escalation decisions in patients with established disease.