MRE viable imaging option for pediatric obscure gastrointestinal bleeding

Magnetic resonance enterography (MRE) could be the new gold standard for children presenting obscure gastrointestinal bleeding (OGIB). 

Though OGIB—a recurrent or persistent bleeding or presence of iron deficient anemia after negative evaluation with upper and lower endoscopy—accounts for a small proportion of gastrointestinal bleeds in pediatric patients, it can lead to death. 

In a study, published in the August 2017 issue of the European Journal of Radiology, researchers, led by Emanuele Casciani, PhD, of the University of Rome, sought to evaluate the performance of MRE in the diagnostic work-up of children presenting OGIB. MRE is currently a preferred imaging modality in the study of children with small bowel disease. 

At present, current adult guidelines recommend capsule endoscopy (CE) as the first-line diagnostic investigation for OGIB, and it has also been used in pediatric populations. However, CE is expensive, time-consuming and has the risk of capsule retention. And there is no specific data highlighting the diagnostic yield of CE in pediatric OGIB cases. 

The authors reported a diagnostic yield of 73 percent, which is comparable to results achieved by capsule endoscopy in adults. Sensitivity and specificity of MRE were 86 percent and 100 percent, respectively. 

With 25 patients, a single-center prospective study was performed on children up to the age of 16 who were referred to the radiology department for OGIB. Each child underwent MRE examination after negative esophagogastroduodenoscopy and ileocolonoscopy. 

  • 19 of the examinations demonstrated positive OGIB results. 
  • 10 of the patients presented occult-type OGIB. 
  • Nine of the patients presented overt-type OGIB. 

“In our experience, it is a safe and accurate imaging modality, with a diagnostic yield that is comparable to CE,” the authors wrote. “However, CE remains the method of choice in the detection of small mucosal lesions, and further research with larger study populations and standardized control groups is warranted to improve our understanding of MRE in this application.”