Fariha Hasan, MD1, Alexander Garcia, DO2, Avneet Singh, DO2, Muhammad Shahzil, MD3, Muhammad YN. Chaudhary, MBChB4, Umm E Salma Shabbar. Banatwala, MBBS5, Syeda Hafsa Qadri, MBBS6, Syeda Alishah Zehra, MBBS5, Ayesha Liaquat, MBBS5, Yumna Timsaal, MBBS5, Manesh Kumar Gangwani, MD7, Apeksha Shah, MD8, Babu Mohan, MD9, Christina Tofani, MD, FACG10 1Cooper University Hospital, Philadelphia, PA; 2Cooper University Hospital, Camden, NJ; 3Penn State Health Milton S. Hershey Medical Center, Hershey, PA; 4Indiana University Southwest, Evansville, IN; 5Dow Medical College, Karachi, Sindh, Pakistan; 6Dow University of Health Sciences, Karachi, Sindh, Pakistan; 7University of Toledo, Toledo, OH; 8Digestive Health Institute at Cooper University Hospital, Mt. Laurel, NJ; 9Orlando Gastroenterology PA, Orlando, FL; 10Digestive Health Institute at Cooper University Hospital, Camden, NJ
Introduction: Computed tomography enterography (CTE), magnetic resonance enterography (MRE), and video capsule endoscopy (VCE) are used to assess disease activity and extent in Crohn’s disease (CD) patients. CTE identifies both intestinal and extraintestinal pathologies but involves radiation exposure. MRE offers superior soft tissue contrast and serves as a safer alternative due to its avoidance of radiation. VCE detects mucosal inflammation more accurately but cannot detect extraintestinal characteristics. This systematic review and meta-analysis aims to evaluate the differences in VCE, CTE, and MRE diagnostic performances in CD.
Methods: PubMed, Embase, Web of Science, and the Cochrane Library databases were searched for studies comparing diagnostic performances of VCE, CTE, and MRE in CD. Standard meta-analysis methods were employed using the random-effects model. Generic inverse variance method to address clinical heterogeneity. Results were considered significant at p < 0.05
Results: The final analysis included thirty-eight studies comprising 2103 patients with suspected CD, out of which 1385, 952, and 899 patients underwent MRE, CTE, and VCE, respectively. Comparable diagnostic yield [OR = 1.59, 95% CI: 0.52-4.86, P =0.41], accuracy [OR = 1.03, 95% CI: 0.43-2.46, P = 0.95], overall specificity [MD = -0.11, 95% CI: -7.81-7.60, P = 0.98], and sensitivity [MD = 5.06, 95% CI: -3.70-13.82, P = 0.26] were shown between VCE and MRE. Similarly, no significant difference in accuracy [OR = 1.30, 95% CI: 0.60-2.82, P = 0.50], overall specificity [MD = 3.63, 95% CI: -1.81-9.08, P = 0.19], or sensitivity [MD = 0.06, 95% CI: -6.98-7.10, P = 0.99] was observed between MRE and CTE. In contrast, a significantly better diagnostic yield [OR = 2.88, 95% CI: 1.49-5.55, P = 0.002] was found with VCE than CTE.
Discussion: VCE, MRE, and CTE are all accurate diagnostic modalities for CD, demonstrating similar accuracy, overall sensitivity, and specificity. However, VCE has a superior diagnostic yield compared to CTE. This may be attributed to its capacity for direct visualization of the mucosal surface and detecting subtle mucosal changes that may not be discernible on cross-sectional imaging. The utility of VCE is limited by issues like stricture or capsule retention, making MRE a safer alternative with comparable efficacy. Future head-to-head comparison studies, especially those combining two modalities and incorporating cost-effectiveness, are needed to guide the choice of primary modality in this patient population.
Note: The table for this abstract can be viewed in the ePoster Gallery section of the ACG 2024 ePoster Site or in The American Journal of Gastroenterology's abstract supplement issue, both of which will be available starting October 27, 2024.
Disclosures:
Fariha Hasan indicated no relevant financial relationships.
Alexander Garcia indicated no relevant financial relationships.
Avneet Singh indicated no relevant financial relationships.
Muhammad Shahzil indicated no relevant financial relationships.
Muhammad Chaudhary indicated no relevant financial relationships.
Umm E Salma Banatwala indicated no relevant financial relationships.
Syeda Hafsa Qadri indicated no relevant financial relationships.
Syeda Alishah Zehra indicated no relevant financial relationships.
Ayesha Liaquat indicated no relevant financial relationships.
Yumna Timsaal indicated no relevant financial relationships.
Manesh Kumar Gangwani indicated no relevant financial relationships.
Apeksha Shah indicated no relevant financial relationships.
Babu Mohan indicated no relevant financial relationships.
Christina Tofani indicated no relevant financial relationships.
Fariha Hasan, MD1, Alexander Garcia, DO2, Avneet Singh, DO2, Muhammad Shahzil, MD3, Muhammad YN. Chaudhary, MBChB4, Umm E Salma Shabbar. Banatwala, MBBS5, Syeda Hafsa Qadri, MBBS6, Syeda Alishah Zehra, MBBS5, Ayesha Liaquat, MBBS5, Yumna Timsaal, MBBS5, Manesh Kumar Gangwani, MD7, Apeksha Shah, MD8, Babu Mohan, MD9, Christina Tofani, MD, FACG10. P0895 - Comparative Diagnostic Performance of VCE, CTE, and MRE in Crohn’s Disease: A Systematic Review and Meta-Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
