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Barium studies and ileoscopy compared in children with suspected Crohn's disease
A Lipson1, C I Bartram, C B Williams
1Department of Paediatric Gastroenterology, St Bartholomew's Hospital, West Smithfield, London.
Insights
Barium follow-through and ileoscopy with biopsy are effective for diagnosing pediatric inflammatory bowel disease. Combining ileoscopy and biopsy offers the highest diagnostic accuracy for Crohn's disease in the terminal ileum.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Imaging
- Endoscopy
Background:
- Chronic inflammatory bowel disease (IBD) diagnosis in children can be challenging.
- Accurate imaging and biopsy are crucial for timely and effective treatment.
Purpose of the Study:
- To compare the diagnostic accuracy of barium follow-through, ileoscopy, and biopsy in children with suspected IBD.
- To evaluate the combined utility of these diagnostic modalities.
Main Methods:
- Retrospective analysis of 46 children with suspected IBD.
- Comparison of findings from barium follow-through, ileoscopy, and terminal ileum biopsy against final clinical diagnosis.
- Calculation of agreement rates and diagnostic accuracy metrics.
Main Results:
- Ileoscopy and barium follow-through agreed in 91% of cases.
- Barium follow-through, ileoscopy, and biopsy together achieved 76% diagnostic agreement.
- Ileoscopy combined with biopsy diagnosed all pediatric IBD cases.
- Barium follow-through showed a sensitivity of 0.90 and specificity of 0.96 for terminal ileum Crohn's disease.
Conclusions:
- Ileoscopy combined with biopsy is the most accurate method for diagnosing pediatric IBD.
- Barium follow-through is a valuable, sensitive, and specific tool for evaluating the terminal ileum in suspected pediatric IBD cases.
- Radiological lymphoid hyperplasia can be a confounding factor in diagnosis.
Abstract:
The findings on barium follow through, ileoscopy and biopsy of the terminal ileum in 46 children with suspected chronic inflammatory bowel disease have been compared to the final clinical diagnosis. Ileoscopy and barium follow through agreed in 91%, barium follow through and biopsy in 80% and barium follow through, ileoscopy and biopsy in 76% of cases. A pronounced lymphoid hyperplasia pattern was present radiologically in 24%, and was a source of error in two cases. Barium follow through compared favourably to ileoscopy or biopsy individually, detecting 18 of 20 and 17 of 20 cases respectively; however, ileoscopy combined with biopsy diagnosed every case. The sensitivity of the barium follow through was 0.90 with a specificity 0.96 for the diagnosis of Crohn's disease in the terminal ileum.