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Capsule endoscopy versus magnetic resonance enterography for the detection of small bowel polyps in Peutz-Jeghers
P Urquhart1, F Grimpen, G J Lim
1The Royal Melbourne Hospital, Parkville, Australia, pcurquhart@hotmail.com.
Insights
Capsule endoscopy (CE) detects more small bowel polyps than magnetic resonance enterography (MRE) in Peutz-Jeghers syndrome (PJS) patients. However, correlation with balloon enteroscopy (BE) findings was poor for both methods.
Area of Science:
- Gastroenterology
- Diagnostic Imaging
- Genetics
Background:
- Peutz-Jeghers syndrome (PJS) is associated with a high risk of gastrointestinal polyps.
- Accurate detection of small bowel polyps is crucial for PJS management and surveillance.
- Current diagnostic modalities for small bowel polyps include magnetic resonance enterography (MRE) and capsule endoscopy (CE).
Purpose of the Study:
- To compare the diagnostic utility of MRE and CE for detecting small bowel polyps in PJS patients.
- To evaluate the correlation of MRE and CE findings with balloon enteroscopy (BE) verification.
- To assess patient preferences between MRE and CE.
Main Methods:
- Prospective study involving 20 adult PJS patients across two tertiary centers.
- Patients underwent both MRE and CE.
- Balloon enteroscopy (BE) was performed for verification in cases with significant polyps (≥10 mm).
Main Results:
- Capsule endoscopy (CE) detected significantly more polyps (47) compared to MRE (14) (P = 0.02).
- CE identified more patients with significant polyps (11) than MRE (7) (P = 0.25).
- Balloon enteroscopy (BE) confirmed polyps in 8 patients, with MRE showing a higher positive predictive value (100%) than CE (60%).
Conclusions:
- Capsule endoscopy (CE) is superior to MRE for detecting small bowel polyps in PJS patients.
- Despite CE's higher detection rate, the correlation between MRE, CE, and BE findings was suboptimal.
- Patient preference favored CE as the preferred investigation method.
Abstract:
Our study aimed to assess the diagnostic utility of magnetic resonance enterography (MRE) compared to capsule endoscopy (CE) for the detection of small bowel polyps in patients with Peutz-Jeghers syndrome (PJS); with findings verified by balloon enteroscopy (BE). Adult patients were prospectively recruited across two tertiary centres and underwent MRE followed by CE, with a subsequent BE performed in patients with significant (≥10 mm) polyps. The primary endpoint was the total number of significant (≥10 mm) small bowel polyps detected. The number of patients with at least one significant polyp, correlation with BE findings, and patients' preferences were secondary endpoints. A total of 20 patients (7 male; mean age 34.9 years) underwent both investigations. The number of polyps ≥10 mm detected by CE was greater than by MRE (47 vs 14 polyps, P = 0.02). The number of patients with at least one significant polyp identified by CE was 11 (55 %) compared with 7 (35 %) identified by MRE (P = 0.25). Subsequent BE in 12 patients identified a total of 26 significant polyps in 8 patients. The positive predictive value of finding a polyp at BE was higher for MRE (100 %) compared to CE (60 %). Overall patient preferences identified CE as the preferred modality. This prospective study demonstrated that CE identifies significantly more small bowel polyps compared with MRE in patients with PJS. Correlation between the two techniques and subsequent BE however was relatively poor.
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