Balloon assisted enteroscopy and Magnetic resonance enterograpy for Small bowel Crohn’s disease

Endoscopic assessment of Crohn`s disease (CD) is crucial, but majority of available evidence is based on ileocolonoscopic data. Small bowel (SB) lesions have been much less studied. We aimed to evaluate the utility of balloon-assisted enteroscopy (BAE) in comparison with magnetic resonance enterography (MRE).
We prospectively collected data from patients with CD who underwent both BAE and MRE. We applied a modified SES-CD for endoscopic evaluation and MaRIA for MRE evaluation.
For inflammatory activity, the lack of SB endoscopic healing was an independent risk factor for clinical relapses (hazard ratio (HR): 5.34) and serological relapses (HR: 3.02), respectively. MR ulcer healing (MaRIA score <11) demonstrated a high diagnostic accuracy (90.9%) for endoscopic healing. The kappa coefficient between BAE and MRE for longitudinal responsiveness was 0.754 for clinical relapse and 0.783 for serological relapse. For SB strictures, the accuracy of MRE was defined by 60.6% sensitivity and 93.4% specificity. BAE-positive strictures were an independent risk factor for surgery (P=0.001). The surgery-free rate in the MR-negative–BAE positive stricture group was significantly lower than that in nonstricture group at 1 year (P=0.001).
Both SB inflammation and strictures were associated with a poor prognosis. MRE is a valid and reliable examination for inflammation. But the specificity of MRE for detection of strictures was clinically sufficient. BAE could identify SB inflammation and strictures, and balloon dilatation for strictures was also available.