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ILEOSCOPY AND BIOPSY (ICB) VS SMALL BOWEL MEAL WITH PNEUMOCOLON (SBMP): A PROSPECTIVE COMPARISON IN ILEAL CROHN’S DISEASE (CD)
JK Marshall, R Cawdron, RH Riddell, K Chorneyko, I Zealley, S Somers, EJ Irvine
McMaster University, Hamilton, Ontario
BACKGROUND AND AIM: CD of the terminal ileum (TI) is generally diagnosed by radiography or endoscopy, but their relative accuracy is unclear. Therefore, we prospectively compared the relative accuracy of ICB and SBMP for diagnosis of TI CD.
METHODS: 120 subjects with diarrhea and clinical features of TI CD underwent SBMP followed within 21d by ICB. Films were reviewed by 2 radiologists unaware of endoscopic reports, and biopsies were interpreted blindly by 2 pathologists. A combined diagnosis for ICB was generated by blinded pathologists (2) and endoscopists (2). The gold standard (GS) diagnosis in the TI for each patient was assessed by a 6-member consensus panel with access to all available clinical data, including study tests.
RESULTS: Ileoscopy and/or ileal biopsy were completed in 100 subjects (83.3%). At SBMP, adequate ileal views were obtained in single-contrast in 119 (99.2%) and double-contrast in 106 (88.3%). The GS TI diagnoses were CD in 48 subjects (40.0%), lymphoid nodular hyperplasia in 24 (20.0%), NSAID enteritis in 1 (0.8%) and normal in 47 (39.2%). The sensitivity, specificity, negative and positive predictive values for the tests were:
CONCLUSIONS: TI biopsy improved the accuracy of ileoscopy. However, in this referred population, ICB and SBMP had similar accuracy, sensitivity, specificity and predictive values. Other factors such as local expertise, access, cost, disease prevalence and patient preference should be considered in selecting diagnostic strategies for patients with symptoms of CD.
Supported by the Medical Research Council of Canada