Mayo study shows ct better than PillCam equal sensitivity and better specificity.
CT Enterography as a Diagnostic Tool in Evaluating Small Bowel Disorders: Review of Clinical Experience with over 700 Cases Scott R. Paulsen, MD, et al.*
Abstract Purpose: In a retrospective analysis of 756 patients who underwent CTE at the Mayo Clinic, the authors described their preferred methods for performing CTE, including the use of a 0.1% barium sulfate suspension, VoLumen, as a preferred oral contrast agent.
Results CTE has begun to replace the small bowel follow-through exam for the investigation of Crohn's disease. �CTE is foreseen by the authors as the modality of choice for ruling out Crohn's disease in patients with a presumed diagnosis of irritable bowel syndrome. �Compared with capsule endoscopy, CTE had equivalent sensitivity and superior specificity in detecting small bowel inflammation.
Conclusion: Mayo Clinic reports that CTE, with low Hounsfield value (LHV) oral contrast as a preferred oral agent, has become "the first-line modality at our institution in patients with suspected inflammatory bowel disease
CT is ALWAYS very dangerous. Its radiation is insane (in order to get as much as possible resolution). Just patients who have suspected cancer tumors should do it. CT does not generate natural color images so the correlation between medical atlas and the CT images is very poor. This is the reason why visual colonscopy is not yet reliable
Tried Google search for Scott R Paulsen--his name does not show up-must be a young MD. Saw Jonathan Leighton-Chair Endoscopy-Arizona.He is upbeat about Capsule Endoscopy results for Crohn. Please note that Endocapsule of Olympus uses CCD chip rather CMOS chip used in M2A of Given with far better image quality. I think CCD technology and ability to position the Capsule where doctor wants will greatly enhance the Capsule Sales in 5 to 8 years.DDW presentations by several persons is an important achievement.Read the abstract of Allison,Van Dam from Stanford at DDW Los Angeles. Note that all these techniques have their place and advantages/disadvantages.What you describe--Paulsen abstract is true--but look at the cost. Traditional procedures can take biopsy etc.where as Capsule is a Screeing device.But Cheap way to Screen has its place for many.
Here is a more complete reference on another paper that comes to the same conclusion as the Mayo Clinic.
Even with these results, assuming new technology from Pillcam can equal sensitivity and specificity of CT, I believe that PillCam can still "win" because the GI guys get nothing if they refer a patient to a Radiologist. The cost of an abdominal CT scan ranges from $500-$1000.
Paper Authors and Reference:
Hara AK, Leighton JA, Heigh RI, et al. Crohn disease of the small bowel: Preliminary comparison among CT enterography, capsule endoscopy, small bowel follow-through, and ileoscopy. Radiology 2006; 238:128-134