Investigating inflammatory bowel disease - White cell scanning, radiology, and colonoscopy

Objective-To evaluate different methods of examination of the bowel in suspected inflammatory bowel disease. Design-Prospective investigation of all children over a three year period with suspected inflammatory bowel disease. A technetium-99m-NMPAO labelled white cell scan (Tc-WCS), barium follow through examination (Ba-FT), and colonoscopy plus biopsy were undertaken. Setting-Great Ormond Street Hospital for Children, London. Subjects-39 children (20 male and 19 female), median age 12.1 years (range 3.9-15.1 years). Main outcome measures-There was total agreement in 21/39 cases, positive in 16, and negative in five. Of 31 histologically proved cases, positive results were obtained in 28 Tc-WCSs (sensitivity 90%), 10 of 24 Ba-FTs (sensitivity 42%), and 27 colonoscopies (sensitivity 87%). Conclusion-The Tc-WCS is sensitive, specific, and non-invasive and should be a first line investigation. Ba-FT with a high radiation burden and relatively low sensitivity requires its role to be redefined. Colonoscopy, with endoscopic biopsy, has a high pick-up rate where facilities and expertise exist.