VCE vs. MRE, CTE & IUS for SB-CD diagnosis

VCE vs. MRE, CTE & IUS for SB-CD diagnosis

October 19, 2025

Issue 20

Clinical Question

Is capsule endoscopy as accurate as advanced imaging for small bowel Crohn’s diagnosis?

Editor’s Bottom Line

Capsule endoscopy performs well for detecting and characterizing small bowel Crohn’s disease, but capsule retention remains a risk.

Reference

Khan S, Dahiya DS, Jadoon AK, et al. A Network Meta-analysis of Capsule Endoscopy Versus Imaging Modalities for Diagnosing Small Bowel Crohn’s Disease. J Crohns Colitis. Epub ahead of print July 15, 2025. https://academic.oup.com/ecco-jcc/advance-article-abstract/doi/10.1093/ecco-jcc/jjaf127/8201466?redirectedFrom=fulltext&login=false

Synopsis

This network meta-analysis compared the diagnostic accuracy of four imaging modalities for detecting small bowel Crohn’s disease (SB-CD): video capsule endoscopy (VCE), magnetic resonance enterography (MRE), computed tomography enterography (CTE) and intestinal ultrasound (IUS).

The analysis included 29 mostly prospective cohort studies with 2,609 patients. Of the total population, 77% had established SB-CD and 23% had suspected SB-CD. VCE was used in 17 studies (702 patients), MRE in 15 studies (882 patients), CTE in eight studies (345 patients) and IUS in nine studies (680 patients).

For overall SB-CD detection, pooled sensitivity and specificity were:

  • VCE: 89.6% (95% Confidence Interval [CI]: 83.3–94.6) and 86.2% (95% CI: 75.4–94.3)
  • MRE: 82.1% (95% CI: 74.3–88.8) and 71.6% (95% CI: 56.7–84.5)
  • CTE: 79.6% (95% CI: 65.5–90.7) and 82.8% (95% CI: 75.7–88.8)
  • IUS: 89.3% (95% CI: 74–98.3%) and 72.1% (95% CI: 52.3–88.3)

Diagnostic accuracy was:

  • VCE: 71.5%
  • MRE: 67.9%
  • CTE: 52.3%
  • IUS: 70.9%

Network meta-analysis demonstrated that VCE exhibited superior diagnostic accuracy compared to CTE (Odds Ratio [OR]: 1.83; 95% CI: 1.12–2.98) and MRE (OR: 1.76; 95% CI: 1.20–2.57) and comparable performance to IUS (OR: 1.58; 95% CI: 0.86–2.93). Performance among MRE, CTE and IUS was similar.

Ranking analysis using P-scores identified VCE as the most effective diagnostic modality, followed by IUS, MRE, and CTE.

In a subgroup analysis of patients with established SB-CD, VCE demonstrated sensitivity of 93.7% and specificity of 86.4% while for suspected SB-CD, VCE showed sensitivity of 92% and specificity of 93.5%.

Subgroup analysis by anatomical location revealed VCE was significantly superior in diagnostic accuracy for proximal SB-CD (45.2%), compared to MRE (11.9%) and CTE (15.3%). For distal SB-CD, VCE demonstrated 54.3% diagnostic accuracy versus 30.6% for MRE and 13.6% for CTE. Network meta-analysis confirmed the superiority of VCE over MRE (OR: 4.50; 95% CI: 1.85–10.9), CTE (OR: 5.3; 95% CI: 1.7–15.9), and IUS (OR: 1.09; 95% CI: 1.09–85.5) for proximal disease detection.

For disease in the terminal ileum, all modalities showed comparable diagnostic performance.

Capsule retention occurred in 3.3% of VCE cases across the 16 studies that reported adverse events.

Details

Study Design: Network meta-analysis and systematic review
Funding: None
Allocation: Not applicable
Setting: International multicenter
Level of Evidence: 1a