S1347 Comparison of Magnetic Resonance Enterography and Balloon Assisted Enteroscopy in the Detection of Active Small Bowel Inflammation in Patients with Crohn’s Disease

Abstract

Introduction: There are several modalities to detect active inflammation in the small intestine in patients with Crohn’s disease. Magnetic resonance (MR) enterography is a recommended non-invasive imaging technique that can detect inflammation, strictures and fistulas. Balloon assisted enteroscopy (BAE) allows direct visualization and sampling of the small intestine. We aimed to compare MRE and BAE in the detection of active small bowel inflammation in patients with Crohn’s disease. Methods: We performed a retrospective analysis of patients with Crohn’s disease who underwent both MRE and BAE between January 2011 and March 2021. All patient charts were analyzed for MRE findings, BAE findings, age, sex, and surgical history. MRE was considered positive for active inflammation if findings included mural thickening, mucosal enhancement, mesenteric edema and lymphadenopathy. BAE was considered positive for active inflammation if ulceration seen and inflammation confirmed on pathology. Results: Retrospective review identified a total of 96 patients with both MRE and BAE performed. A total of 18 patients were excluded since the time between MRE and BAE was greater than one year. Of the remaining 78 patients, 40 patients (51.2%) had a history of prior Crohn’s related surgery. Three BAE (3.7%) were unsuccessful in reaching small intestine findings seen on MRE due to stricture or adhesions. The agreement of a lack of active inflammation between MRE and BAE findings occurred in 17 patients (21.7%). MRE and BAE agreed with the presence of active inflammation in 34 patients (43.5%). In three patients (3.7%), MRE showed active inflammation but BAE did not find any visual or pathologic evidence of active inflammation. In 19 patients (24.3%), MRE was negative for active inflammation but BAE was positive. When compared to the other groups, this group had higher rates of prior surgery (63.2%) and higher rates of inflammatory stricture (52.6%). Conclusion: In patients with Crohn’s disease, MRE and BAE are helpful modalities in detecting active inflammation in the small intestine. In patients with a history of Crohn’s related surgery, BAE may be more helpful in determining presence of active inflammation or inflammatory strictures. Despite history of surgery, BAE is successful in reaching small bowel lesions.