Small-bowel imaging in Crohn's disease: a prospective, blinded, 4-way comparison trial

Gastrointest Endosc. 2008 Aug;68(2):255-66. doi: 10.1016/j.gie.2008.02.017. Epub 2008 Jun 2.


Background: With the introduction of new techniques to image the small bowel, there remains uncertainty about their role for diagnosing Crohn's disease.

Objective: To assess the sensitivity and specificity of capsule endoscopy (CE), CT enterography (CTE), ileocolonoscopy, and small-bowel follow-through (SBFT) in the diagnosis of small bowel Crohn's disease.

Methods: Prospective, blinded trial.

Setting: Inflammatory bowel disease clinic at an academic medical center.

Patients: Known or suspected Crohn's disease. Exclusion criteria included known abdominal abscess and non-steroidal anti-inflammatory drug (NSAID) use. Partial small-bowel obstruction (PSBO) at CTE excluded patients from subsequent CE.

Interventions: Patients underwent all 4 tests over a 4-day period.

Main outcome measurements: Sensitivity, specificity, and accuracy of each test to detect active small-bowel Crohn's disease. The criterion standard was a consensus diagnosis based upon clinical presentation and all 4 studies.

Results: Forty-one CTE examinations were performed. Seven patients (17%) had an asymptomatic PSBO. Forty patients underwent colonoscopy, 38 had SBFT studies, and 28 had CE examinations. Small-bowel Crohn's disease was active in 51%, absent in 42%, inactive in 5%, and suspicious in 2% of patients. The sensitivity of CE for detecting active small-bowel Crohn's disease was 83%, not significantly higher than CTE (83%), ileocolonoscopy (74%), or SBFT (65%). However, the specificity of CE (53%) was significantly lower than the other tests (P < .05). One patient developed a transient PSBO due to CE, but no patients had retained capsules.

Limitation: Use of a consensus clinical diagnosis as the criterion standard-but this is how Crohn's disease is diagnosed in practice.

Conclusions: The sensitivity of CE for active small-bowel Crohn's disease was not significantly different from CTE, ileocolonoscopy, or SBFT. However, lower specificity and the need for preceding small-bowel radiography (due to the high frequency of asymptomatic PSBO) may limit the utility of CE as a first-line test for Crohn's disease.

Publication types

  • Clinical Trial
  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Barium Sulfate
  • Capsule Endoscopy / methods*
  • Colonoscopy / methods
  • Confidence Intervals
  • Crohn Disease / diagnosis*
  • Diagnostic Imaging / methods*
  • Enema
  • Female
  • Humans
  • Intestine, Small / diagnostic imaging
  • Intestine, Small / pathology*
  • Male
  • Middle Aged
  • Probability
  • Prospective Studies
  • Risk Assessment
  • Sensitivity and Specificity
  • Single-Blind Method
  • Tomography, X-Ray Computed


  • Barium Sulfate