Background: Video capsule enteroscopy (VCE) has revolutionized small bowel imaging, enabling visual\r\nexamination of the mucosa of the entire small bowel, while MR enteroclysis (MRE) and CT enteroclysis (CTE) have\r\nlargely replaced conventional barium enteroclysis. A new indication for MRE and CTE is the clinical suspicion of\r\nsmall bowel strictures, as indicated by delayed or non-delivery of a test capsule given before a VCE examination, to\r\nexclude stenosis. The aim of this study was to determine the clinical value of subsequent MRE and CTE in patients\r\nin whom a test capsule did not present itself in due time.\r\nMethods: Seventy-five consecutive patients were identified with a delayed or unnoticed delivery of the test\r\ncapsule. Seventy patients consented to participate and underwent MRE (44) or CTE (26). The medical records and\r\nimaging studies were retrospectively reviewed and symptoms, laboratory results and imaging findings recorded.\r\nResults: Lesions compatible with Crohns disease were shown by MRE in 5 patients, by CTE in one and by VCE in\r\nfour, one of whom had lesions on MRE. In patients without alarm symptoms and findings (weight loss,\r\nhaematochezia, anaemia, nocturnal diarrheoa, ileus, fistula, abscess and abnormal blood tests) imaging studies did\r\nnot unveil any such lesion. VCE�s were performed in only 20 patients, mainly younger than 50 years of age,\r\nalthough no stenotic lesion was shown by MRE and CTE. In the remaining 50 patients no VCE or other endoscopic\r\nintervention was performed indicating that the referring physician was content with the diagnostic information\r\nfrom MRE or CTE.\r\nConclusion: The diagnostic value of MRE and CTE is sufficient for clinical management of most patients with\r\nsuspected small bowel disease, and thus VCE may be omitted or at least postponed for later usage.
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