Videokapselendoskopie im Vergleich zur Magnetresonanztomographie bei Vorliegen einer mittleren gastrointestinalen Blutung

The diagnosis of middle gastrointestinal bleeding poses a particular challenge, as the small bowel cannot be satisfactorily illustrated through endoscopic or radiological methods. Capsule endoscopy, which allows the noninvasive visualization of mucosa throughout the entire small bowel, has its main indication in the obscure gastronintestinal bleeding. The most important application of magnetic resonance enteroclysis (MRE) consists in the illustration of the Crohn’s disease and small intestine tumours, both possible causes for small bowel bleeding, as well as intestinal obstruction. The Centre for Diagnostic Radiology at the University of Marburg conducted a study on 21 patients who underwent MRE and CE diagnosis in the period between April 2003 and February 2006. For 19 of the patients middle gastrointestinal bleeding was suspected. The findings were retrospectively analysed for the presence of a potential source of bleeding in the small intestine, with specific focus on the comparison of the two diagnostic methods. Whilst in eleven cases (57.9%) a cause for gastronintestinal bleeding could be found in the small intestinal area, the source of bleeding remained unclear in 6 cases (31.6%), and in 2 cases (10.5%) a different cause for iron deficiency anemia could be found during further treatment. In the present study, CE was found to be clearly superior for the detection of bleeding sources with a 91% sensitivity against 18% for MRE. This could be ascribed to the disproportionately better detection of vascular lesions. Based on our findings, MRE should not be recommended as a first line examination for obscure gastrointestinal bleeding. For suspected intestinal obstruction or Crohn’s disease however, MRE could play a role to eliminate the presence of stenosis prior to conducting a CE. For a number of small intestine pathologies, for instance middle gastrointestinal bleeding caused by Crohn’s disease or tumours, VCE and MR enteroclysis could be used as complemental methods. Through VCE, small lesions of the mucous membrane which escape MRE can be described, while MRE provides additional mural and extramural information.