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Prospective blinded comparison of wireless capsule endoscopy and multiphase CT enterography in obscure
James E Huprich1, Joel G Fletcher, Jeff L Fidler
1Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA. huprich@mayo.edu
Insights
Multiphase computed tomographic (CT) enterography shows higher sensitivity than capsule endoscopy for detecting small bowel bleeding sources and masses in obscure gastrointestinal bleeding (OGIB) patients. CT enterography should be considered in the diagnostic work-up for OGIB.
Area of Science:
- Gastroenterology
- Radiology
- Diagnostic Imaging
Background:
- Obscure gastrointestinal bleeding (OGIB) presents a diagnostic challenge.
- Capsule endoscopy is a common tool for evaluating OGIB.
- Limitations exist in capsule endoscopy's ability to detect certain small bowel pathologies.
Purpose of the Study:
- To compare the diagnostic performance of multiphase computed tomographic (CT) enterography against capsule endoscopy.
- To evaluate the effectiveness of CT enterography in identifying small bowel bleeding sources and masses in patients with OGIB.
Main Methods:
- Prospective study involving 58 adult patients with OGIB.
- Patients underwent both CT enterography and capsule endoscopy.
- Radiologists interpreted CT enterography blinded to clinical data and capsule endoscopy results.
- Comparison with a reference standard (surgery/endoscopy) and clinical follow-up.
Main Results:
- CT enterography demonstrated significantly higher sensitivity (88%) compared to capsule endoscopy (38%) for detecting small bowel bleeding sources (P = .008).
- CT enterography was superior in depicting small bowel masses (100% vs 33%, P = .03).
- A small bowel bleeding source was identified in 28% of patients.
Conclusions:
- Multiphase CT enterography offers superior sensitivity for detecting small bowel bleeding and masses in OGIB patients.
- CT enterography should be considered in the routine diagnostic work-up for OGIB.
- CT enterography may be particularly beneficial for patients with negative capsule endoscopy findings.
Purpose:
To compare the performance of multiphase computed tomographic (CT) enterography with that of capsule endoscopy in a group of patients with obscure gastrointestinal bleeding (OGIB).
Materials And Methods:
This prospective HIPAA-compliant study was approved by the institutional review board and the institutional conflict of interest committee. All patients provided written informed consent. Two radiologists, blinded to clinical data and results of capsule endoscopy, interpreted images from CT enterography independently, with discordant interpretations resolved by consensus. Results were compared with those from a reference standard (surgery or endoscopy) and clinical follow-up. Sensitivity and 95% confidence intervals were calculated for each modality.
Results:
Fifty-eight adult patients, referred for the evaluation of OGIB (occult, 25 patients [43%]; overt, 33 patients [57%]), underwent both tests. A small bowel bleeding source was identified in 16 of the 58 patients (28%). The sensitivity of CT enterography was significantly greater than that of capsule endoscopy (88% [14 of 16 patients] vs 38% [six of 16 patients], respectively; P = .008), largely because it depicted more small bowel masses (100% [nine of nine patients] vs 33% [three of nine patients], respectively; P = .03). No additional small bowel tumors were discovered during the follow-up period (range, 5.6-45.9 months; mean, 16.6 months).
Conclusion:
In this referral population, the sensitivity of CT enterography for detecting small bowel bleeding sources and small bowel masses was significantly greater than that of capsule endoscopy. On the basis of these findings, the addition of multiphase CT enterography to the routine diagnostic work-up of patients with OGIB should be considered, particularly in patients with negative findings at capsule endoscopy.
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