Comparison of the use of wireless capsule endoscopy with magnetic resonance enterography in children with inflammatory bowel disease

Table 1 Summery of studies comparing imaging modalities to capsule endoscopy

Author /year / type	Country	Age group/ total No.	Patient population	Modalities compared to CE	Results
Albert 2005[14]	Germany	Adults/52	Established and suspected CD	MRE	Diagnostic yield of WCE is superior to MRE ( +ve MRE 32/52 vs +ve WCE 25/27)
Golder 2006 prospective[15]	Germany	Adults/16	Established CD	MRE	Diagnostic yield of WCE is similar to that of MRE ( +ve MRE 9/15 vs +ve WCE 11/15), but the WCE is superior in detecting proximal SB disease
Tillack 2008 prospective[16]	Germany	Adults/19	Established CD	MRE	Diagnostic yield of WCE is similar to that of MRE (+ve MRE 18/19 vs +ve WCE 18/19) but the WCE is superior in detecting proximal SB disease
Dionisio 2010 prospective	Europe, Canada, Israel and United States	All ages/ 428	Established and suspected CD	CTE and SBFT and MRE	Diagnostic yield of WCE is superior to that of CTE and SBR in suspected CD but it is similar to MRE in suspected and established CD
Metanalysis[17]
Crook 2009 prospective[18]	Switzerland	Adults/5	Suspected CD	MRE	Diagnostic yield of WCE is similar to that of MRE and complementary to each other
Bocker 2010 prospective[19]	Germany	Adults/21	Established and suspected CD	MRE	Diagnostic yield of WCE is similar to that of MRE ( +ve MRE 6/21 vs +ve WCE 9/21) but the WCE is superior in detecting proximal SB disease
Jensen 2011 prospective[20]	Denmark	Adults/93	Established and suspected CD	MRE	Diagnostic yield of WCE is similar to that of MRE( +ve MRE 24/80 vs +ve WCE 22/80) but the WCE is superior in detecting proximal SB disease
Wiarda 2011 prospective[21]	The Netherlands	Adults/38	Established and suspected CD	MRE	Diagnostic yield of WCE is similar that of MRE ( +ve MRE 16/38 vs +ve WCE 6/25)
Kopylov 2015 prospective[22]	Israel	Adults/77	Established CD	MRE	Diagnostic yield of WCE is similar to that of MRE ( +ve MRE 40/52 vs +ve WCE 42/52) but the WCE is superior in detecting proximal SB disease
Gonzalez Suarez 2017 retrospective[23]	Spain	Adults/47	Established and suspected CD	MRE	WCE is superior to MRE in detection of small bowel lesions mainly proximal(+ve WCE 36/47 vs +ve MRE 21/47)
Di Nardo 2010 prospective[24]	Italy	Peds/117	Established and suspected CD	MRI and SICUS	reclassifying indeterminate colitis (IC) into CD (60%), detection of CD lesions in known CD (41%) and establishing new diagnosis in suspected CD (50%)
Casciani 2011 prospective[13]	Italy	Peds/60	suspected CD	MRE	Diagnostic yield of WCE is similar to that of MRE ( +ve MRE 19/37 vs +ve WCE 10/60)
Gralnek 2012 prospective[25]	Israel	Peds /18	Established and suspected CD	No studies compared
Kovanlikaya 2013[11] retrospective	United States	Peds/23	Established and suspected CD	MRE	Sensitivity of MRE 75% was similar to WCE 77.8%
Aloi 2015 prospective[9]	Italy	Peds/25	Established and suspected CD	MRE and SICUS	Diagnostic yield of WCE is similar to that of MRE and SICUS ( +ve MRE 15/25 vs +ve SICUS 16/25 vs +ve WCE 16/25) but the WCE is superior in detecting proximal SB disease
Oliva 2016 prospective[12]	Italy	Peds/38	Established CD	MRE and SICUS	Diagnostic yield of WCE is similar to that of MRE and SICUS ( +ve MRE 19/38 vs +ve WCE 19/38 vs +ve SICUS 21/38) but the CCE is superior in detecting proximal SB disease

WCE: Wireless capsule endoscopy; CCE: Colon capsule endoscopy; SBR: Small bowel radiography; CTE: Computed tomography enterography; MRE: Magnetic resonance enterography; SICUS: Small intestinal contrast ultrasonography; CD: Crohn’s disease; IC: Indeterminate colitis; Peds: Pediatric; +ve: Positive.

Table 2 Highlights baseline characteristics of patient’s demographics and clinical and endoscopic descriptions

	All patients CD and IC n = 27	CD n = 20
Age at diagnosis year	13.46 (2.40)	13.48 (2.02)
Male %	74%	75%
Medications ratio (%)
Biological alone or combination therapy	12/27 (44.4%)	11/20 (55%)
Immune modulators with no biologic combination	8/27 (30%)	5/20 (25%)
5 ASA +- steroids	4/27 (15%)	3/20 (15%)
Steroids alone	2/27 (7%)	0/20 (0%)
Antibiotic alone	1/27 (4%)	1/20 (5%)
Phenotype%
Inflammatory	93%	93%
Stricturing	7%	7%
Duration of disease year	1.7 (2.32)	2.1 (2.57)
BMI percentile	57 (32.9)	58.18 (35.83)
PCDAI	10.2 (12.5)	9.8 (11.6)
SB transit time min	233 (115.4)	241(184.99)
Days between MRE and WCE days	4.19 (1.88)	4 (1.90)

Baseline characteristics of all patients expressed in mean (SD) and the ratio (percentage). CD Crohn’s disease, IC indeterminate colitis, ASA amino salicylate, SB small bowel, BMI body mass index, MRE magnetic resonance enterography, PCDAI pediatric Crohn’s disease activity index WCE wireless capsule endoscopy.

Table 3 Magnetic resonance imaging and wireless capsule endoscopy positivity predictive of small bowel involvement in reference pediatric Crohn’s disease activity index > 10 and to histology

	Reference standard is PCDAI > 10 indicate active CD				Reference standard is histology in ileum and duodenum
	CD only patients (n = 20)				Histology available samples only (n = 14)
	MRE		WCE		MRE		WCE
	Value	95%CI	Value	95%CI	Value	95%CI	Value	95%CI
SEN	100%	54.07% to 100%	83.3%	35.88% to 99.58%	62.50%	24.49% to 91.48%	50.00%	15.70% to 84.30%
SP	57.14%	28.86% to 82.34%	78.6%	49.20% to 95.34%	50.00 %	11.81% to 88.19%	83.33 %	35.88% to 99.58%
PPV	50%	35.32% to 64.68%	62.5%	36.49% to 82.86%	62.50%	38.87% to 81.37%	80.00%	36.99% to 96.46%
NNP	100%		91.7%	64.29% to 98.53%	50.00 %	23.14% to 76.86%	55.56 %	36.43% to 73.17%
Accuracy	70%	45.72 to 88.11%	80.0%	56.34% to 94.27%	57.14%	28.86-82.34%	64.29%	35.14% to 87.24%

SEN: Sensitivity; SP: Specificity; PPN: Positive predictive value; NNP: Negative predictive value; MRE: Magnetic resonance enterography; PCDAI: Pediatric Crohn’s Disease Activity Index; WCE: Wireless capsule endoscopy; CD: Crohn’s disease.

Table 4 Fischer exact performance of each diagnostic test compared to other modality or pediatric Crohn’s disease activity index

Studies compared	All patients (n = 26)	CD only (n = 20)
MRE and WCE	P = 0.428	P = 0.373
MRE and PCDAI	P = 0.395	P = 0.325
WCE and PCDAI	P =0.1892	P = 0.0181

MRE: Magnetic resonance enterography; PCDAI: Pediatric Crohn’s Disease Activity Index; WCE: Wireless capsule endoscopy; CD: Crohn’s disease.