Clin Endosc.  2022 Jul;55(4):532-539. 10.5946/ce.2021.224.

Capsule enteroscopy versus small-bowel ultrasonography for the detection and differential diagnosis of intestinal diseases

  • 1Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
  • 2Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy


Capsule enteroscopy (CE) and intestinal ultrasonography (IUS) are techniques that are currently used for investigating small-bowel (SB) diseases. The aim of this study was to compare the main imaging findings and the lesion detection rate (LDR) of CE and IUS in different clinical scenarios involving the SB.
We retrospectively enrolled patients who underwent CE and IUS for obscure gastrointestinal bleeding (OGIB), complicated celiac disease (CeD), and suspected or known inflammatory bowel disease (IBD). We evaluated the LDR of both techniques. The accuracy of IUS was determined using CE as the reference standard.
A total of 159 patients (113 female; mean age, 49±19 years) were enrolled. The LDR was 55% and 33% for CE and IUS (p<0.05), respectively. Subgroup analysis showed that the LDR of CE was significantly higher than that of IUS in patients with OGIB (62% vs. 14%, p<0.05) and CeD (55% vs. 35%, p<0.05). IUS showed a similar LDR to CE in patients with suspected or known IBD (51% vs. 46%, p=0.83).
CE should be preferred in cases of OGIB and CeD, whereas IUS should be considered an early step in the diagnosis and follow-up of IBD even in patients with a proximal SB localization of the disease.


Capsule enteroscopy; Celiac disease; Inflammatory bowel diseases; Intestinal ultrasonography; Lesion detection rate


  • Fig. 1. Correspondence between ultrasonographic signs and findings of capsule enteroscopy divided into atrophy, erosive inflammation, and nonerosive inflammation. The percentages in black indicate the correspondence with atrophy, those in red indicate the correspondence with erosive inflammation, and those in orange indicate the correspondence with nonerosive inflammation.


1. Monkemuller K. Should we illuminate the black box of the small bowel mucosa from above or below? Clin Gastroenterol Hepatol. 2012; 10:917–919.
2. Eliakim R, Carter D. Endoscopic assessment of the small bowel. Dig Dis. 2013; 31:194–198.
3. Fidler JL, Goenka AH, Fleming CJ, et al. Small bowel imaging: computed tomography enterography, magnetic resonance enterography, angiography, and nuclear medicine. Gastrointest Endosc Clin N Am. 2017; 27:133–152.
4. Pennazio M, Spada C, Eliakim R, et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2015; 47:352–376.
5. Maconi G, Bianchi Porro G. Ultrasound of the gastrointestinal tract. 2nd ed. Berlin, Heidelberg: Springer;2014.
6. Wale A, Pilcher J. Current role of ultrasound in small bowel imaging. Semin Ultrasound CT MR. 2016; 37:301–312.
7. Parente F, Maconi G, Bollani S, et al. Bowel ultrasound in assessment of Crohn’s disease and detection of related small bowel strictures: a prospective comparative study versus x ray and intraoperative findings. Gut. 2002; 50:490–495.
8. Fraquelli M, Colli A, Casazza G, et al. Role of US in detection of Crohn disease: meta-analysis. Radiology. 2005; 236:95–101.
9. Nylund K, Hausken T, Odegaard S, et al. Gastrointestinal wall thickness measured with transabdominal ultrasonography and its relationship to demographic factors in healthy subjects. Ultraschall Med. 2012; 33:E225–E232.
10. Nylund K, Maconi G, Hollerweger A, et al. EFSUMB recommendations and guidelines for gastrointestinal ultrasound: part 1: examination techniques and normal findings (long version). Ultraschall Med. 2017; 38:e1–15.
11. Fraquelli M, Castiglione F, Calabrese E, et al. Impact of intestinal ultrasound on the management of patients with inflammatory bowel disease: how to apply scientific evidence to clinical practice. Dig Liver Dis. 2020; 52:9–18.
12. Nylund K, Odegaard S, Hausken T, et al. Sonography of the small intestine. World J Gastroenterol. 2009; 15:1319–1330.
13. Fraquelli M, Colli A, Colucci A, et al. Accuracy of ultrasonography in predicting celiac disease. Arch Intern Med. 2004; 164:169–174.
14. Branchi F, Locatelli M, Tomba C, et al. Enteroscopy and radiology for the management of celiac disease complications: time for a pragmatic roadmap. Dig Liver Dis. 2016; 48:578–586.
15. Marmo R, Rotondano G, Piscopo R, et al. Meta-analysis: capsule enteroscopy vs. conventional modalities in diagnosis of small bowel diseases. Aliment Pharmacol Ther. 2005; 22:595–604.
16. Aloi M, Di Nardo G, Romano G, et al. Magnetic resonance enterography, small-intestine contrast US, and capsule endoscopy to evaluate the small bowel in pediatric Crohn’s disease: a prospective, blinded, comparison study. Gastrointest Endosc. 2015; 81:420–427.
17. Kopylov U, Yung DE, Engel T, et al. Diagnostic yield of capsule endoscopy versus magnetic resonance enterography and small bowel contrast ultrasound in the evaluation of small bowel Crohn’s disease: systematic review and meta-analysis. Dig Liver Dis. 2017; 49:854–863.
18. Carter D, Katz LH, Bardan E, et al. The accuracy of intestinal ultrasound compared with small bowel capsule endoscopy in assessment of suspected Crohn’s disease in patients with negative ileocolonoscopy. Therap Adv Gastroenterol. 2018; 11:1756284818765908.
19. Orlando S, Fraquelli M, Coletta M, et al. Ultrasound elasticity imaging predicts therapeutic outcomes of patients with Crohn’s disease treated with anti-tumour necrosis factor antibodies. J Crohns Colitis. 2018; 12:63–70.
20. Rezapour M, Amadi C, Gerson LB. Retention associated with video capsule endoscopy: systematic review and meta-analysis. Gastrointest Endosc. 2017; 85:1157–1168.e2.
Full Text Links
  • CE
export Copy
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: