P141 Comparison of diagnostic accuracy of videocapsule endoscopy and CT/MR enterography in patients with established small bowel Crohn’s disease
P. Andrade*, H. Cardoso, R. Gaspar, J. Santos-Antunes, M. Marques, S. Lopes, G. Macedo
Centro Hospitalar São João, Gastroenterology, Oporto, Portugal
Advances in enterography imaging techniques and videocapsule endoscopy (CE) have led to a widespread use of these noninvasive methods. The best strategy for detecting active disease in patients with established small bowel Crohn’s disease (CD) using VCE and/or enterography imaging techniques is not well defined. The aim of this study was to assess the accuracy of videocapsule endoscopy (VCE) and magnetic resonance (MR) or computed tomography (CT) enterography for diagnosing active small bowel CD and analyse the concordance between VCE and enterography techniques findings.
Patients with established small bowel CD who underwent both VCE and CT/MR enterography at our tertiary referral central were included. Both procedures were completed within 3 months of each other. We analysed findings in VCE (Lewis score was calculated) and CT/MR enterography and assessed the concordance of both methods. Diagnostic accuracy of CT/MR enterography compared with VCE was also determined.
We included 89 patients, 54% women with a mean age of 39 ± 14 years. In 4 cases the VCE did not reach the distal ileum. VCE detected active disease in 53 (62%) patients in the distal ileum, 22 (25%) patients in the proximal ileum, and 26 (29%) patients in the jejunum. CT/MR enterography detected active disease in 53 (62%) patients in the distal ileum, 10 (11%) patients in the proximal ileum, and 6 (7%) patients in the jejunum. Concordance between VCE and CT/MR enterography findings was higher in the distal ileum (kappa = 0.45, moderate) than in the proximal ileum (kappa = 0.33, fair) or the jejunum (kappa = 0.08, poor). The global correlation coefficient kappa was 0.31 (fair). Compared with VCE, the sensitivity, specificity, positive predictive value, and negative predictive value of CT/MR enterography were, respectively, 79%, 66%, 79%, and 66%in the distal ileum; 32%, 95%, 70%, and 81% in the proximal ileum; and 11%, 95%, 59% and 72%, in the jejunum.
VCE had a higher diagnostic accuracy to detect active disease in patients with established small bowel CD because of a higher sensitivity in proximal segments (jejunum and proximal ileum). VCE and CT/MR enterography findings were more concordant in distal ileum than in proximal segments.