Prospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 28, 2019; 25(28): 3808-3822
Published online Jul 28, 2019. doi: 10.3748/wjg.v25.i28.3808
Comparison of the use of wireless capsule endoscopy with magnetic resonance enterography in children with inflammatory bowel disease
Nadia Mazen Hijaz, Thomas Mario Attard, Jennifer Marie Colombo, Neil Joseph Mardis, Craig Alan Friesen
Nadia Mazen Hijaz, Thomas Mario Attard, Jennifer Marie Colombo, Neil Joseph Mardis, Craig Alan Friesen, Division of Gastroenterology Hepatology and Nutrition, University of Missouri Kansas City, Children’s Mercy Hospital Kansas City, Kansas City, MO 64108, United States
Author contributions: Hijaz NM has designed the research study under the guidance of Attard TM and Colombo JM. Hijaz NM supervised the recruitment, safety and timed performance of every single aspect of study procedures. Hijaz NM has collected, processed, computed and summarized all the data. Attard TM and Colombo JM have participated in the capsule endoscopy reading of the study. Mardis NJ has participated in reading the magnetic resonance imaging of the study. Hijaz NM, Attard TM, Friesen CA analyzed the data statistically. Hijaz NM wrote the paper and then revised with guidance of Attard TA, Colombo JM, Friesen CA and Mardis NJ.
Supported by the donation of wireless Small bowel capsule and patency capsules from Giving imaging, Ltd Medtronic company with the funding agreement from Given investigator-initiated study No. 13-12.
Institutional review board statement: The study was reviewed and approved by the institutional review boards of Children's Mercy Hospital Pediatric Institutional Review Board, IRB #13080263.
Clinical trial registration statement: The clinical trial is registered with, using identifier NCT02182947. Details can be found at
Informed consent statement: All study participants, or their legal guardian, provided written consent prior to study enrollment.
Conflict-of-interest statement: All authors of this manuscript have no conflict of interest to disclose.
Data sharing statement: There is no additional data available.
CONSORT 2010 statement: Not applicable.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Nadia Mazen Hijaz, MD, Assistant Professor, Doctor, Division of Gastroenterology Hepatology and Nutrition, University of Missouri Kansas City, Children Mercy Hospital Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States.
Telephone: +1-816-3023400 Fax: +1-816-3029735
Received: March 22, 2019
Peer-review started: March 22, 2019
First decision: April 16, 2019
Revised: May 4, 2019
Accepted: July 5, 2019
Article in press: July 5, 2019
Published online: July 28, 2019

Magnetic resonance enterography (MRE) and wireless capsule endoscopy (WCE) are equally accepted modalities for noninvasive screening of small bowel involvement (SBI) in children with Crohn’s disease (CD) and indeterminate colitis (IC) albeit there is a paucity of data comparing the two and thereby guiding the clinician in selecting the ideal diagnostic approach. Therefore, the goal of this study is to provide additional evidence for capsule endoscopy role in the evaluation of established Crohn’s disease exacerbation compared to MRE in relation to Pediatric Crohn's Disease Activity Index (PCDAI), and histological indices.


To prospectively compare the findings of MRE and WCE and their agreement with PCDAI or histology in children with CD or IC.


Consecutive patients diagnosed with CD and IC were screened for inclusion. After informed consent, patient’s demographic and clinical data was abstracted. The current pediatric disease activity index (PCDAI) and endoscopic findings were included. Patients underwent MRE and WCE including preprocedural patency capsule within a maximum of 7 d of each other. Pathological presence of active small bowel disease in ileal and duodenal biopsies were collected if the endoscopy was performed within 2 mo of the WCE study. Patients who failed to pass the PC were excluded from the study. WCE was read by two different experienced gastroenterologists (Attard TM and Colombo JM) blinded to each other's findings and to the findings on MRE (Mardis NJ). Agreement between WCE reviewers, WCE and MRE findings and concordance between positive PCDAI and SBI based on MRE compared with WCE was computed.


Forty-five patients were included in the study, 18 withdrew and 27 (20 males and 20 CD), mean age (standard deviation) 13.46 (2.4) years, completed the study protocol. There were no instances of capsule retention. Concordance between gastroenterologist reviewers was excellent for the diagnosis of small intestinal CD with good correlation between the two Lewis scores (r = 0.875, P < 0.001). Concordance between WCE and MRE was poor (69%). In CD patients, when both MRE and WCE were compared using PCDAI > 10 as the standard reference reflecting active small intestinal CD, the sensitivity of MRE and WCE were 100% and 83% respectively and the specificity of MRE and WCE were 57.14% and 78.6%, respectively. If the histology in ileum or/and duodenum was used as the reference for active small bowel involvement, WCE had a higher specificity as compared to MRE (83.3% vs 50%). In patients with Crohn’s disease, those with a positive PCDAI (> 10) were more likely to have a positive WCE as compared to those with a negative PCDAI (83% vs 21%; P = 0.018).


We suggest that MRE and WCE have a complementary role in the assessment of SBI in CD. WCE detected SBI with a much higher specificity while MRE had a higher sensitivity.

Keywords: Crohn’s disease, Wireless capsule endoscopy, Inflammatory bowel disease, Magnetic resonance enterography, Small bowel involvement, Small bowel disease, Indeterminate colitis, Pediatric, Children

Core tip: There are a number of prospective adult studies and few in pediatrics comparing magnetic resonance imaging (MRE) to wireless capsule endoscopy (WCE) in identifying small bowel (SB) Crohn’s disease (CD) that showed no significant difference in the diagnostic yield and accuracy of MRE and WCE in established non-stricturing crohns disease or suspected and established CD together. This study is the first prospective study in children with established inflammatory bowel disease in the United States assessing and comparing the roles of MRE and WCE in identifying SB disease involvement in relation to clinical and histological indices.