DOI: 10.1148/rg.253045134
Imaging of Small Bowel Disease: Comparison of Capsule Endoscopy, Standard Endoscopy, Barium Examination, and CT1
Amy K. Hara, MD,
Jonathan A. Leighton, MD,
Virender K. Sharma, MD,
Russell I. Heigh, MD and
David E. Fleischer, MD
1 From the Departments of Radiology (A.K.H.) and Gastroenterology (J.A.L., V.K.S., R.I.H., D.E.F.), Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259. Recipient of a Cum Laude award for an education exhibit at the 2003 RSNA Scientific Assembly. Received June 16, 2004; revision requested July 16 and received August 18; accepted August 20. All authors have no financial relationships to disclose.
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Figure 1. Photograph shows the capsule (26 x 11 mm) in relation to a dime.
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Figure 2. Drawing illustrates sensors attached to the abdomen, along with the battery pack and recorder.
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Figure 3a. Bleeding angioectasia in a patient with obscure gastrointestinal bleeding. (a) Capsule endoscopic image shows angioectasia (circled) in an area of gross blood. (b) Angiogram shows angioectasia in the jejunum. (c) Intraoperative endoscopic image helps confirm the presence of bleeding angioectasia in the jejunum.
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Figure 3b. Bleeding angioectasia in a patient with obscure gastrointestinal bleeding. (a) Capsule endoscopic image shows angioectasia (circled) in an area of gross blood. (b) Angiogram shows angioectasia in the jejunum. (c) Intraoperative endoscopic image helps confirm the presence of bleeding angioectasia in the jejunum.
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Figure 3c. Bleeding angioectasia in a patient with obscure gastrointestinal bleeding. (a) Capsule endoscopic image shows angioectasia (circled) in an area of gross blood. (b) Angiogram shows angioectasia in the jejunum. (c) Intraoperative endoscopic image helps confirm the presence of bleeding angioectasia in the jejunum.
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Figure 4. Gastrointestinal stromal tumor. Coronal CT scan shows a gastrointestinal stromal tumor (circled), a finding that was confirmed surgically. Capsule endoscopy was nondiagnostic due to retained food.
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Figure 5a. Familial polyposis in a patient with negative findings at small bowel follow-through examination and CT. Capsule endoscopic (a) and esophagogastroduodenoscopic (EGD) (b) images show multiple small polyps in the proximal small bowel (arrows in a).
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Figure 5b. Familial polyposis in a patient with negative findings at small bowel follow-through examination and CT. Capsule endoscopic (a) and esophagogastroduodenoscopic (EGD) (b) images show multiple small polyps in the proximal small bowel (arrows in a).
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Figure 6a. Lymphangioma. (a) Capsule endoscopic image shows multiple punctate white lesions (circled) in the proximal small bowel. (b) Intraoperative endoscopic image shows markedly thickened small bowel folds. (c) CT scan shows circumferential low-attenuation wall thickening in a jejunal segment (circled) causing narrowing of the lumen and enlargement of the small bowel loop. (d) Intraoperative photograph shows marked distention of a jejunal loop, a finding that corresponds to the abnormality seen at CT.
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Figure 6b. Lymphangioma. (a) Capsule endoscopic image shows multiple punctate white lesions (circled) in the proximal small bowel. (b) Intraoperative endoscopic image shows markedly thickened small bowel folds. (c) CT scan shows circumferential low-attenuation wall thickening in a jejunal segment (circled) causing narrowing of the lumen and enlargement of the small bowel loop. (d) Intraoperative photograph shows marked distention of a jejunal loop, a finding that corresponds to the abnormality seen at CT.
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Figure 6c. Lymphangioma. (a) Capsule endoscopic image shows multiple punctate white lesions (circled) in the proximal small bowel. (b) Intraoperative endoscopic image shows markedly thickened small bowel folds. (c) CT scan shows circumferential low-attenuation wall thickening in a jejunal segment (circled) causing narrowing of the lumen and enlargement of the small bowel loop. (d) Intraoperative photograph shows marked distention of a jejunal loop, a finding that corresponds to the abnormality seen at CT.
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Figure 6d. Lymphangioma. (a) Capsule endoscopic image shows multiple punctate white lesions (circled) in the proximal small bowel. (b) Intraoperative endoscopic image shows markedly thickened small bowel folds. (c) CT scan shows circumferential low-attenuation wall thickening in a jejunal segment (circled) causing narrowing of the lumen and enlargement of the small bowel loop. (d) Intraoperative photograph shows marked distention of a jejunal loop, a finding that corresponds to the abnormality seen at CT.
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Figure 7a. Bleeding cavernous hemangioma in a patient with obscure gastrointestinal bleeding. (a) Capsule endoscopic image shows hemorrhage in the proximal small bowel. (b) EGD image shows a suspected submucosal mass in the jejunum. (c) Axial CT scan shows a small soft-tissue mass in the jejunum (circled). (d) Coronal CT scan shows the small soft-tissue mass in the jejunum (circled) with punctate calcifications. (e) Intraoperative photograph shows a small bleeding cavernous hemangioma in the jejunal wall.
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Figure 7b. Bleeding cavernous hemangioma in a patient with obscure gastrointestinal bleeding. (a) Capsule endoscopic image shows hemorrhage in the proximal small bowel. (b) EGD image shows a suspected submucosal mass in the jejunum. (c) Axial CT scan shows a small soft-tissue mass in the jejunum (circled). (d) Coronal CT scan shows the small soft-tissue mass in the jejunum (circled) with punctate calcifications. (e) Intraoperative photograph shows a small bleeding cavernous hemangioma in the jejunal wall.
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Figure 7c. Bleeding cavernous hemangioma in a patient with obscure gastrointestinal bleeding. (a) Capsule endoscopic image shows hemorrhage in the proximal small bowel. (b) EGD image shows a suspected submucosal mass in the jejunum. (c) Axial CT scan shows a small soft-tissue mass in the jejunum (circled). (d) Coronal CT scan shows the small soft-tissue mass in the jejunum (circled) with punctate calcifications. (e) Intraoperative photograph shows a small bleeding cavernous hemangioma in the jejunal wall.
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Figure 7d. Bleeding cavernous hemangioma in a patient with obscure gastrointestinal bleeding. (a) Capsule endoscopic image shows hemorrhage in the proximal small bowel. (b) EGD image shows a suspected submucosal mass in the jejunum. (c) Axial CT scan shows a small soft-tissue mass in the jejunum (circled). (d) Coronal CT scan shows the small soft-tissue mass in the jejunum (circled) with punctate calcifications. (e) Intraoperative photograph shows a small bleeding cavernous hemangioma in the jejunal wall.
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Figure 7e. Bleeding cavernous hemangioma in a patient with obscure gastrointestinal bleeding. (a) Capsule endoscopic image shows hemorrhage in the proximal small bowel. (b) EGD image shows a suspected submucosal mass in the jejunum. (c) Axial CT scan shows a small soft-tissue mass in the jejunum (circled). (d) Coronal CT scan shows the small soft-tissue mass in the jejunum (circled) with punctate calcifications. (e) Intraoperative photograph shows a small bleeding cavernous hemangioma in the jejunal wall.
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Figure 8a. Adenocarcinoma. (a) Capsule endoscopic image demonstrates blood in the proximal small bowel. (b) EGD image shows a bleeding lobulated mass. (c) Image from a small bowel follow-through study demonstrates an irregular jejunal bowel loop (circled) representing adenocarcinoma. The examination was initially thought to be negative. (d) CT scan shows diffuse, irregular thickening of the jejunal loop (circled), a finding that corresponds to the tumor.
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Figure 8b. Adenocarcinoma. (a) Capsule endoscopic image demonstrates blood in the proximal small bowel. (b) EGD image shows a bleeding lobulated mass. (c) Image from a small bowel follow-through study demonstrates an irregular jejunal bowel loop (circled) representing adenocarcinoma. The examination was initially thought to be negative. (d) CT scan shows diffuse, irregular thickening of the jejunal loop (circled), a finding that corresponds to the tumor.
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Figure 8c. Adenocarcinoma. (a) Capsule endoscopic image demonstrates blood in the proximal small bowel. (b) EGD image shows a bleeding lobulated mass. (c) Image from a small bowel follow-through study demonstrates an irregular jejunal bowel loop (circled) representing adenocarcinoma. The examination was initially thought to be negative. (d) CT scan shows diffuse, irregular thickening of the jejunal loop (circled), a finding that corresponds to the tumor.
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Figure 8d. Adenocarcinoma. (a) Capsule endoscopic image demonstrates blood in the proximal small bowel. (b) EGD image shows a bleeding lobulated mass. (c) Image from a small bowel follow-through study demonstrates an irregular jejunal bowel loop (circled) representing adenocarcinoma. The examination was initially thought to be negative. (d) CT scan shows diffuse, irregular thickening of the jejunal loop (circled), a finding that corresponds to the tumor.
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Figure 9. Carcinoid tumor. Capsule endoscopic image shows a carcinoid tumor measuring 1.7 cm in diameter that was not detected at barium examination or CT. (Reprinted, with permission, from reference 2.)
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Figure 10a. Lymphoma. (a) Capsule endoscopic image shows small nodules in the jejunum. (b) EGD image demonstrates an irregular lobulated mass. (c) Image from a small bowel follow-through study demonstrates an abnormal jejunal small bowel loop (circled). The examination was initially thought to be negative. (d) CT scan shows eccentric irregular thickening of the jejunal loop (circled), a finding that represents lymphoma.
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Figure 10b. Lymphoma. (a) Capsule endoscopic image shows small nodules in the jejunum. (b) EGD image demonstrates an irregular lobulated mass. (c) Image from a small bowel follow-through study demonstrates an abnormal jejunal small bowel loop (circled). The examination was initially thought to be negative. (d) CT scan shows eccentric irregular thickening of the jejunal loop (circled), a finding that represents lymphoma.
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Figure 10c. Lymphoma. (a) Capsule endoscopic image shows small nodules in the jejunum. (b) EGD image demonstrates an irregular lobulated mass. (c) Image from a small bowel follow-through study demonstrates an abnormal jejunal small bowel loop (circled). The examination was initially thought to be negative. (d) CT scan shows eccentric irregular thickening of the jejunal loop (circled), a finding that represents lymphoma.
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Figure 10d. Lymphoma. (a) Capsule endoscopic image shows small nodules in the jejunum. (b) EGD image demonstrates an irregular lobulated mass. (c) Image from a small bowel follow-through study demonstrates an abnormal jejunal small bowel loop (circled). The examination was initially thought to be negative. (d) CT scan shows eccentric irregular thickening of the jejunal loop (circled), a finding that represents lymphoma.
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Figure 11a. Ovarian cancer invading the terminal ileum. (a) Capsule endoscopic image shows a small bowel stricture of unknown origin (arrows) causing obstruction of the capsule. (b) CT scan shows the capsule (circled) in the distal ileum. (c) CT scan shows a large, heterogeneous mass (arrow) invading the terminal ileum and causing a small bowel stricture. (d) CT scan shows the invasive mass arising from the right ovary.
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Figure 11b. Ovarian cancer invading the terminal ileum. (a) Capsule endoscopic image shows a small bowel stricture of unknown origin (arrows) causing obstruction of the capsule. (b) CT scan shows the capsule (circled) in the distal ileum. (c) CT scan shows a large, heterogeneous mass (arrow) invading the terminal ileum and causing a small bowel stricture. (d) CT scan shows the invasive mass arising from the right ovary.
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Figure 11c. Ovarian cancer invading the terminal ileum. (a) Capsule endoscopic image shows a small bowel stricture of unknown origin (arrows) causing obstruction of the capsule. (b) CT scan shows the capsule (circled) in the distal ileum. (c) CT scan shows a large, heterogeneous mass (arrow) invading the terminal ileum and causing a small bowel stricture. (d) CT scan shows the invasive mass arising from the right ovary.
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Figure 11d. Ovarian cancer invading the terminal ileum. (a) Capsule endoscopic image shows a small bowel stricture of unknown origin (arrows) causing obstruction of the capsule. (b) CT scan shows the capsule (circled) in the distal ileum. (c) CT scan shows a large, heterogeneous mass (arrow) invading the terminal ileum and causing a small bowel stricture. (d) CT scan shows the invasive mass arising from the right ovary.
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Figure 12. Small bowel ulcers. Capsule endoscopic image shows small bowel ulcers that were not seen at enteroclysis or CT.
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Figure 13a. Early Crohn disease. (a) Image from a small bowel follow-through study shows mild nodularity in the terminal ileum (arrows). (b) CT scan shows mild diffuse wall thickening and mucosal enhancement of the terminal ileum (arrow). (c) Capsule endoscopic image shows a small apthous ulcer in the terminal ileum (circled).
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Figure 13b. Early Crohn disease. (a) Image from a small bowel follow-through study shows mild nodularity in the terminal ileum (arrows). (b) CT scan shows mild diffuse wall thickening and mucosal enhancement of the terminal ileum (arrow). (c) Capsule endoscopic image shows a small apthous ulcer in the terminal ileum (circled).
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Figure 13c. Early Crohn disease. (a) Image from a small bowel follow-through study shows mild nodularity in the terminal ileum (arrows). (b) CT scan shows mild diffuse wall thickening and mucosal enhancement of the terminal ileum (arrow). (c) Capsule endoscopic image shows a small apthous ulcer in the terminal ileum (circled).
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Figure 14a. Early Crohn disease in another patient. (a) Image from a small bowel follow-through study shows mild nodularity in the terminal ileum (arrow). (b) CT scan shows mild diffuse wall thickening and markedly increased mucosal enhancement of the terminal ileum (arrow). (c) Capsule endoscopic image shows a small apthous ulcer in the terminal ileum (circled).
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Figure 14b. Early Crohn disease in another patient. (a) Image from a small bowel follow-through study shows mild nodularity in the terminal ileum (arrow). (b) CT scan shows mild diffuse wall thickening and markedly increased mucosal enhancement of the terminal ileum (arrow). (c) Capsule endoscopic image shows a small apthous ulcer in the terminal ileum (circled).
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Figure 14c. Early Crohn disease in another patient. (a) Image from a small bowel follow-through study shows mild nodularity in the terminal ileum (arrow). (b) CT scan shows mild diffuse wall thickening and markedly increased mucosal enhancement of the terminal ileum (arrow). (c) Capsule endoscopic image shows a small apthous ulcer in the terminal ileum (circled).
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Figure 15a. NSAID-induced stricture resulting in a retained capsule. (a) Capsule endoscopic image shows a small bowel stricture. The capsule became impacted at this point. (b) CT scan shows the capsule (circled) impacted in the ileum. (c) Photograph shows the retained capsule lodged in the stricture.
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Figure 15b. NSAID-induced stricture resulting in a retained capsule. (a) Capsule endoscopic image shows a small bowel stricture. The capsule became impacted at this point. (b) CT scan shows the capsule (circled) impacted in the ileum. (c) Photograph shows the retained capsule lodged in the stricture.
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Figure 15c. NSAID-induced stricture resulting in a retained capsule. (a) Capsule endoscopic image shows a small bowel stricture. The capsule became impacted at this point. (b) CT scan shows the capsule (circled) impacted in the ileum. (c) Photograph shows the retained capsule lodged in the stricture.
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Copyright © 2005 by the Radiological Society of North America.
