Original article
Clinical endoscopy
Capsule endoscopy in patients with Crohn's disease: diagnostic yield and safety

https://doi.org/10.1016/j.gie.2009.06.034Get rights and content

Background

Capsule endoscopy (CE) is increasingly used in patients with suspected or known Crohn's disease (CD).

Objective

To determine the diagnostic yield of CE and the distribution of small-bowel (SB) lesions in symptomatic patients with known CD.

Design and Setting

Retrospective review of CE procedures performed in patients with CD between 2001 and 2005 in a tertiary care center.

Patients

One hundred thirty-four patients with an established diagnosis of CD and symptoms suggestive of active disease.

Interventions

Swallowing the capsule.

Main Outcome Measurements

Diagnostic yield of CE and distribution of SB lesions in patients with CD.

Results

One hundred forty-six CE procedures were performed on 134 CD patients. Fifty-two (39%) of 134 patients had CE findings diagnostic of active CD (>3 ulcerations), and 17 (13%) had findings suggestive of active CD (≤3 ulcerations). Fifty-seven (42%) patients had normal findings, and 6% had normal but incomplete studies. The distribution of SB lesions was 32% in the duodenum, 53% in the jejunum, 67% in the proximal ileum, and 85% in the distal ileum. CE was comparable to ileoscopy in detecting ileal ulcerations (55% vs 48%), but superior to SB follow-through in detecting CD lesions in the SB (incremental yield of 32%; 95% CI, 9%-54%; P = .0017).

Limitations

Retrospective study from a single center.

Conclusions

CE identified SB lesions in approximately half of symptomatic CD patients. Large-scale prospective studies are needed to evaluate whether positive CE findings may affect disease outcomes.

Section snippets

Patient selection

The medical records of 134 nonconsecutive patients known to have CD who had undergone CE at Cedars-Sinai Medical Center (CSMC; Los Angeles, CA) between October 2001 and December 2005 were retrospectively reviewed. The diagnosis of CD was established by using traditional endoscopic (colonoscopy with ileoscopy) and radiographic techniques such as SBFT. Indications for performing CE included abdominal pain, overt or occult GI bleeding (GIB), diarrhea, and weight loss. Patients with obstructive

Characteristics of the CD patient cohort

One hundred thirty-four symptomatic CD patients underwent 146 CE procedures between October 2001 and December 2005. The patients' characteristics are shown in Table 1. The mean age of the patient cohort was 37.7 years (range 9-77 years), with 44% being males. The majority (81%) of patients had ileal or ileocolonic disease. All patients had their colonic disease in remission or had minimal disease activity, which prompted the treating physician to request a CE procedure to determine whether the

Discussion

Our study represents the largest series on the use of CE in patients with an established diagnosis of CD to determine the safety and diagnostic yield of CE in this group of patients. Our study shows that CE is a valuable diagnostic tool in revealing active SB CD with a high diagnostic yield of approximately 50% when both diagnostic and suspicious findings of CD were considered. In addition, it seems to be safe and well tolerated in this group of patients as long as patients with suspected

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    DISCLOSURE: The authors disclosed no financial relationships relevant to this publication.

    If you would like to chat with an author of this article, you may contact Dr. Papadakis at [email protected] or [email protected].

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