Imaging of inflammatory bowel disease. How?

Abstract

Imaging of the small bowel has changed radically over the last few years. It is still the case that the mesenteric small intestine has not been conquered by fibre-optic endoscopy and the small bowel remains the most difficult segment of the alimentary tract to examine because of its unique anatomy and remote location. However, the changes that have been led by advances in adult practice are rapidly being included in paediatric practice and the landscape has changed beyond recognition. Traditionally the small bowel (barium) follow through (SBFT) has been the investigation of choice for that otherwise inaccessible length of gut between the duodenum and the ileocaecal valve. Whilst it is still a widely practised examination by radiologists [1] it is being largely overtaken by other imaging modalities with CT, MRI and capsule endoscopy (CE) all competing for the territory. At the end of the last century, proponents of enteroclysis were predicting the eventual decline of the SBFT (in adults) [2] although at that stage, in a ‘state of the art’ article, they were still brave enough to say that ‘only in the small bowel does barium radiography remain unchallenged’. The same authors now write of how radiological investigations complement other techniques [3] but are no longer the mainstay. In 1981, an engineer called Iddan, with expertise in electro-optics, had the original science-fiction-like concept of a tiny capsule that could pass through the gut recording information and transmitting it to the ‘outside world’. In collaboration with a gastroenterologist, the idea was developed, and in 1994 they applied for patents and started feasibility studies. Separately, another gastroenterologist, Swain, together with his colleagues in the UK, showed the first live transmission of the pig intestinal mucosa using commonly available electronic components. Iddan and Swain then collaborated [4] and in 2000 human studies began. The FDA approved the capsule endoscope for clinical use in adults in 2001 and for use in children aged 10– 18 years in 2003. It is used off licence in younger children; with the youngest child being reported so far being 18 months of age. It is more commonly used in children from about the age of 4 or 5 years upwards.