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P160 Diagnostic yield of capsule endoscopy versus magnetic resonance enterography and small bowel contrast ultrasound for evaluation of small bowel Crohn's disease: a systematic review and meta-analysis

Kopylov U.*1, Young D.2, Engel T.3, Vijayan S.2, Har-Noy O.1, Katz L.3, Avni T.4, Eliakim R.3, Ben-Horin S.3, Koulaouzidis A.2

1Sheba Medical Center, Gastroenterology, Tel Hashomer, Israel 2Royal Infirmary of Edinburgh, Endoscopy Unit, Centre for Liver and Digestive Disorders, Edinburgh, United Kingdom 3Chaim Sheba Medical Center, Gastroenterology, Ramat Gan, Israel 4Rabin Medical Center, Internal Medicine, Petach Tikva, Israel

Background

Crohn's disease (CD) involves the small bowel (SB) in at least 70% of those affected. Capsule endoscopy (CE), magnetic resonance enterography (MRE) and SB intestinal contrast ultrasound (SICUS) are the modalities of choice for SB evaluation. In CD, proximal SB disease is associated with worse long-term outcomes. This study aimed to compare the diagnostic yield (DY) of CE, MRE and SICUS in detection and monitoring of SB CD by performing a systematic review and meta-analysis of the available literature.

Methods

MEDLINE and EMBASE searches were performed using the search terms “capsule endoscopy”, “ultrasound”, “magnetic resonance enterography” and “Crohn's disease”. We retrieved prospective trials comparing the accuracy of CE, MRE and SICUS for detection of active SB disease in patients with suspected and established CD. Only prospective studies comparing CE with at least one additional diagnostic modality were included. Odds ratios (ORs) for DY with 95% confidence intervals (CIs) were calculated. Where data were available, DY was also analyzed separately for proximal and distal SB.

Results

A total of 138 studies were retrieved by the literature search; 12 studies were eligible for analysis. The DYs of CE, MRE and SICUS were similar for the overall population. The OR for DY of CE vs MRE was 0.56 (95% CI 0.28–1.13, p=0.1; I2=72%; 9 studies, 376 patients). The OR for CE vs SICUS was 0.85 (95% CI 0.69–1.38; p=0.23; I2=15%l 4 studies, 122 patients) (Fig. 1).

The DY for distal SB disease was similar to the overall analysis, OR 1.58 (95% CI 0.56–4.46; p=0.41; I2=71%; 6 studies, 220 patients). Segmental analysis was not possible for SICUS due to a low number of studies.

Figure 1

DY was similar in suspected and established CD. Comparing CE to MRE, CE had superior DY for proximal SB disease with OR 2.62 (95% CI 1.10–6.53; p=0.03; I2=71%; 6 studies, 220 patients) (Fig. 2).

Figure 2

Conclusion

CE, MRE and SICUS have similar DY for detection of SB CD in both suspected and established CD. CE was superior to MRE for detection of proximal SB involvement; this may have important practical implications due to the prognostic impact of SB disease.