Lee Hyun Seok, Lim Yun Jeong, Jung Jin-Hee, Nam Ji Hyung, Park Junseok, Kang Sun Hyung, Kim Ki Bae, Chun Hoon Jai
Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea.
Department of Internal Medicine, Dongguk University College of Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea.
Gastroenterol Res Pract. 2020 Apr 4;2020:8129525. doi: 10.1155/2020/8129525. eCollection 2020.
Studies comparing magnetic resonance enterography (MRE) and capsule endoscopy (CE) for the assessment of small bowel (SB) Crohn's disease (CD) are scarce in Korea. In addition, there is no Korean experience of patency capsule (PC) examination prior to CE. The primary aim of this study was to compare diagnostic yields of MRE and CE for the assessment of SB CD. Secondary objectives were to compare the detection rate of proximal SB lesions by each modality in the Montreal classification and evaluate the safety and feasibility of PC in Korean CD patients.
MRE was performed as the first examination to assess SB CD. PC examination and CE were then performed. Diagnostic yields of active SB disease by MRE and CE were then analyzed.
Disintegration of the patency capsule was shown in 5 patients out of 26 patients, who did not undergo CE. These 5 patients were accounted as negative CE findings. Overall, MRE and CE detected 80.8% and 65.4% of active SB lesions of CD in 26 patients, respectively ( = 0.212). MRE and CE detected 0% (0/26) and 19.2% (5/26) ( = 0.051) of jejunal lesions, 30.8% (8/26) and 42.3% (11/26) ( = 0.388) of proximal ileal lesions, and 80.8% (21/26) and 53.8% (14/26) ( = 0.039) of terminal ileal lesions, respectively. According to the Montreal classification, MRE and CE independently detected proximal disease (L4) in 30.8% (8/26) and 53.8% (14/26) ( = 0.092), respectively.
The diagnostic yields of MRE and CE for the assessment of SB CD including proximal SB lesions were similar. MRE is a more objective tool for detecting clinically relevant stricture than PC although PC examination could be performed safely before CE to prove the patency of SB. This trial is registered with KCT0004305.
在韩国，比较磁共振小肠造影（MRE）和胶囊内镜（CE）用于评估小肠（SB）克罗恩病（CD）的研究较少。此外，韩国尚无在CE检查前进行通畅性胶囊（PC）检查的经验。本研究的主要目的是比较MRE和CE评估SB CD的诊断率。次要目的是比较每种检查方法在蒙特利尔分类中近端SB病变的检出率，并评估PC在韩国CD患者中的安全性和可行性。
首先进行MRE检查以评估SB CD。然后进行PC检查和CE检查。接着分析MRE和CE对活动性SB疾病的诊断率。
26例未进行CE检查的患者中有5例显示通畅性胶囊解体。这5例患者被计为CE检查阴性结果。总体而言，MRE和CE分别在26例患者中检测出CD活动性SB病变的80.8%和65.4%（P = 0.212）。MRE和CE分别检测出空肠病变的0%（0/26）和19.2%（5/26）（P = 0.051）、近端回肠病变的30.8%（8/26）和42.3%（11/26）（P = 0.388）、末端回肠病变的80.8%（21/26）和53.8%（14/26）（P = 0.039）。根据蒙特利尔分类，MRE和CE分别独立检测出近端疾病（L4）的比例为30.8%（8/26）和53.8%（14/26）（P = 0.092）。
MRE和CE评估包括近端SB病变在内的SB CD的诊断率相似。尽管在CE检查前可安全地进行PC检查以证明SB的通畅性，但MRE是检测临床相关狭窄比PC更客观的工具。本试验已在韩国临床试验注册中心注册，注册号为KCT0004305。
