Original articleAlimentary tractEndoscopic Skipping of the Distal Terminal Ileum in Crohn's Disease Can Lead to Negative Results From Ileocolonoscopy
Section snippets
Study Population and Design
An electronic search of Mayo Clinic databases was employed to identify all patients with a diagnosis of Crohn's disease who were evaluated at Mayo Clinic, Rochester, Minnesota, during the year 2009. We identified 189 consecutive patients who had both CTE and ileocolonoscopy (with or without TI intubation) as part of their work-up for Crohn's disease. The 2 tests had to be completed within 30 days of each other. The CTEs were performed according to a previously reported protocol.11 The presence
Results
A total of 189 consecutive patients with Crohn's disease who had both CTE and ileocolonoscopy as part of their evaluation were identified (Figure 1). Eighty-five were men (45%) (median age, 45 years; range, 10–78 years) and 104 were women (55%) (median age, 41 years; range, 14–80 years). Nearly a quarter of the Crohn's disease patients were current smokers (22.8%) and almost an equal number were former smokers (23.3%). Most patients had disease duration of more than 5 years (61.0%). Disease was
Discussion
The results from this retrospective study indicate that up to 54% of patients with active small bowel or upper gut Crohn's disease may have a normal ileoscopy. This can be the result of either intramural and mesenteric disease or skipping of the distal TI. Patients with small bowel disease not detected by ileoscopy had a more recent onset (≤5 years) of disease duration and tended to have more perianal disease when compared with patients with small bowel Crohn's disease visualized by ileoscopy.
Acknowledgments
Presented in part at the Annual Meeting of the American Gastroenterological Association (Digestive Disease Week 2011), Chicago, Illinois, May 8–10, 2011.
References (34)
- et al.
Computerized tomography enterography and its role in small-bowel imaging
Clin Gastroenterol Hepatol
(2008) - et al.
CT enterography: principles, technique and utility in Crohn's disease
Eur J Radiol
(2009) - et al.
Small-bowel imaging in Crohn's disease: a prospective, blinded, 4-way comparison trial
Gastrointest Endosc
(2008) - et al.
The value of ileoscopy with biopsy in the diagnosis of intestinal Crohn's disease
Gastrointest Endosc
(1984) - et al.
The distribution of small bowel Crohn's disease in children compared to adults
Clin Radiol
(1994) - et al.
Is ileoscopy with biopsy worthwhile in patients presenting with symptoms of inflammatory bowel disease?
Am J Gastroenterol
(1998) - et al.
Predictors of Crohn's disease
Gastroenterology
(2006) - et al.
The natural history of adult Crohn's disease in population-based cohorts
Am J Gastroenterol
(2010) - et al.
Assessment of small bowel Crohn disease: noninvasive peroral CT enterography compared with other imaging methods and endoscopy–feasibility study
Radiology
(2003) - et al.
CT enterography as a diagnostic tool in evaluating small bowel disorders: review of clinical experience with over 700 cases
Radiographics
(2006)
CT enterography for Crohn's disease: accurate preoperative diagnostic imaging
Dis Colon Rectum
Radiographic findings of the National Cooperative Crohn's Disease Study
Gastroenterology
Is routine ileoscopy useful?An observational study of procedure times, diagnostic yield, and learning curve
Am J Gastroenterol
Prospective comparison of state-of-the-art MR enterography and CT enterography in small-bowel Crohn's disease
AJR Am J Roentgenol
High incidence of upper gastrointestinal tract involvement in children with Crohn disease
Pediatrics
Adult Crohn disease: can ileoscopy replace small bowel radiology?
Abdom Imaging
Crohn Disease: mural attenuation and thickness at contrast-enhanced CT enterography–correlation with endoscopic and histologic findings of inflammation
Radiology
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Conflicts of interest The authors disclose no conflicts.