ADULT CROHN-DISEASE - CAN ILEOSCOPY REPLACE SMALL-BOWEL RADIOLOGY

Background: This study aimed to document the radiological features and distribution of small bowel Crohn disease (CD) in adults by using a b arium follow-through (BaFT) technique and to determine whether disease would be missed or its distribution underestimated if only colonoscop y with ileoscopy were performed.Methods: The BaFT examinations of 121 adults with proven CD were reviewed retrospectively with respect to th e stage and distribution of disease. Colonoscopy with attempted ileosc opy was performed in 37 of these subjects, and the results were compar ed with radiological findings. Results: A normal villous pattern was v isualized in 89 studies (74%). BaFT showed small bowel CD in 71 (59%) of 121 patients studied. The terminal ileum (TI) was the most common s ite of disease, affecting 62 (87%) of patients with small bowel CD, Fo rty-six patients (65%) had more proximal small bowel disease, includin g nine (13%) with a normal TI. BaFT showed early mucosal changes of CD in 52 subjects (73%), which was the sole manifestation in 15 (21%). I leoscopy was possible in the majority of patients colonoscoped but was not achieved in 14 (38%), nine of whom had CD on BaFT. Of the 23 pati ents in whom ileoscopy was performed, findings agreed with BaFT assess ment of the TI in 22. Conclusion: BaFT adequately demonstrates the sta ge and extent of small bowel CD. The majority of patients with small b owel CD have disease proximal to the TI, which cannot be diagnosed by ileoscopy.