Background/Aims: Although push enteroscopy (PE) is an effective diagnostic tool in Medicine in identifying small bowel (SB) disease, it is not widely used in Pediatrics. The aim of our study was to combine PE and intravenous gadolinum enhanced MRI(G-MRI) to diagnose SB Crohn's disease (CD). Methods: Thirty-six (M20:F16) consecutive patients, 7-19 years of age, with suspected IBD underwent G-MRI of abdomen. PE and cecal colonoscopy with ileal intubation were performed to obtain tissue samples for histologic confirmation. Standard radiological, endoscopic (Figure) and histologic criteria were used for diagnosis. Statistical analysis was performed using STATA 6.0® software. Results: PE obtained tissue samples confirmed the diagnosis of CD in 34(94.4%) patients with suspected proximal SB disease on G-MRI. Of these, 8(22.2%) patients had lesions within the reach of conventional upper intestinal endoscopy (UIE) to the second portion of duodenum. Nineteen (52.8%) patients had their diagnosis made solely on the basis of PE specimens compared to 4(11%) within the reach of UIE. PE therefore improved the diagnostic yield by 72.2% and resulted in a significant change in clinical management in 28(77.7%) patients (new medications, altered dose of medications, new diet, and therapeutic endoscopy beyond the reach of UE). There were no complications related to the procedures. Conclusions: PE has superior diagnostic accuracy compared to UIE. The combination of G-MRI and PE improves the diagnostic yield for proximal SB disease. Larger prospective trials are needed to confirm the feasibility of PE in Pediatric IBD.