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Early Experience with CT Enterography (CTE) in Patients Before Video Capsule Endoscopy (VCE) Daniel S. Mishkin, Brian C. Lucey Background: With the advent of VCE, we are able to evaluate the mucosa of the entire small bowel (SB) in a non-invasive manner. However, capsule retention may occur in 1-5% of studies, depending on the indication. A small bowel follow through (SBFT) has traditionally been the radiographic study of choice for examining the SB lumen and to identify a stricture that may lead to capsule retention. CTE using 64 row detector CT and VoLumen , a negative oral contrast agent, offers an imaging alternative to the SBFT that circumvents some of the difficulties associated with interpreting the SBFT series. Methods: We performed a retrospective analysis of all patients at our institution that have undergone a CTE before undergoing a VCE, to evaluate its clinical usefulness. All patients for a VCE are booked through one Gastroenterologist. The data was evaluated to assess if CTE can both predict potential capsule retention and identify SB pathology when compared to VCE. Results: A total of 20 CTE studies have been performed as a preVCE assessment. Thirteen patients have undergone both tests, while 4 are awaiting VCE. The remaining 3 cases had significant intraluminal changes that altered management and no VCE was performed.Of the 13 cases with both studies, one CTE documented a transition point and proximal dilatation of the SB without a complete obstruction. The SBFT did not identify a transition point and was interpreted as negative. The patient still underwent a capsule study and required surgical removal of a retained capsule at the identified sites. Three VCE studies documented SB neoplasms that were not visualized on CTE. Three patients had vascular ectasias seen on VCE with normal CTE, and one case questioned SB mucosal thickening with a normal VCE. There were no significant extraluminal findings in any patient to date. Conclusion: CTE provides an alternative imaging modality to visualize the small intestine in a non-invasive manner. In our preliminary evaluation it has identified pre-VCE patients at high risk of capsule retention and may become a screening test to identify small bowel patency prior to VCE. The ability of CTE to identify mucosal defects is limited, as it did not identify vascular ectasias or the few cases of a suspected SB neoplasm seen on VCE. Importantly, a few patients did not need to undergo a VCE following CTE as it identified a significant abnormality that explained their clinical status. The data to date is limited. With the advancement of our ongoing prospective trial, we will be able to better assess whether CTE pre-VCE avoids a non-natural passage of the capsule and helps make the correct diagnosis. |
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