Optimizing multiple diagnostic modalities for small bowel evaluation: a strategic approach

Over the past two decades, the small bowel, once considered a diagnostic "blind spot," has become fully and comprehensively accessible. This review summarizes recent advances in the main diagnostic modalities: capsule endoscopy (CE), device-assisted enteroscopy (DAE), computed tomography enterography (CTE), magnetic resonance enterography (MRE), and intestinal ultrasound (IUS). CE provides a noninvasive assessment of mucosal abnormalities, whereas DAE offers the added benefits of tissue sampling and therapeutic intervention. CTE and MRE provide complementary cross-sectional information on mural inflammation, strictures, and extraintestinal involvement. IUS has emerged as a valuable, radiation-free technique for repeated bedside monitoring. We review the diagnostic performance, strengths, and limitations of each modality in key clinical scenarios, including suspected small bowel bleeding, Crohn's disease, and tumors. Finally, we highlight the importance of an integrated, patient-centered approach to optimize the evaluation of small bowel disease and to guide clinical decision-making.