Capsule video endoscopy in Crohn's disease—the European experience

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Capsule endoscopy in patients with suspected small bowel disease or occult gastrointestinal bleeding

Eight studies have been published, in either abstract form or as complete articles in peer-reviewed journals (Table 1).

Costamagna et al [11] have recently published their prospective trial comparing CE to SBFT in 22 consecutive patients with suspected small bowel pathology. In this study small bowel radiographs preceded capsule ingestion by 4 days. Two patients were excluded because of strictures found on radiographs. Of the remaining 20 patients 13 had obscure bleeding, 3 were suspected to

The performance of capsule endoscopy in patients with suspected Crohn's disease

Four studies examined the performance of CE in patients with suspected CD (Table 2). Rodriguez-Tellez et al [19] examined the diagnostic yield of CE in non-confirmed CD. Twenty-one patients in whom SBFT had ruled out stenotic inflammatory lesions underwent CE. Nine of 21 had pathologic findings on CE (43%) consistent with CD. Most of the lesions were located in the ileum, beyond the reach of the colonoscope, four of the nine had jejunal lesions and one had duodenal lesions also.

Capsule endoscopy in patients with known Crohn's disease

Three studies examined the role of CE in patients with known CD. Fork et al [23] from Sweden reported their experience in 14 patients with known CD. In their prospective study they compared CE to small bowel enema and endoscopic procedures. Their initial report evaluated 14 patients with known or suspected CD. One patient could not ingest the capsule and four had delayed gastric emptying of more than 5 hours. The CE detected minor changes (scars, distorted villous architecture, and erosions) in

Convenience and safety of the capsule in Crohn's disease

All together, 147 patients with either suspected or known CD have ingested the CE and approximately another 30 were diagnosed as suffering from CD during their evaluation by CE for occult gastrointestinal bleeding. All but one swallowed the capsule without any difficulty. In three patients, one with known CD and two with occult bleeding, there was non-passage of the capsule because of stricturing CD that necessitated elective surgery (3 out of 177 with Crohn's, 1.7%). SBFT provided no clue to

Summary

These collective data clearly demonstrate that CE is an important new tool with a higher diagnostic yield in recognizing CD than any other method available. CE can diagnose CD especially at its early stages: it is useful in patients with suspected CD when radiographs are either negative or merely suspicious. A negative small bowel follow through in a patient suspected of suffering from CD cannot be taken as evidence that this patient does not have CD. This patient should undergo a capsule

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      Furthermore, the small bowel (SB), an area that is difficult to access with traditional endoscopic methods, is the most common location of GI GVHD [3]. Wireless capsule endoscopy (WCE) is a noninvasive technology allowing for complete SB evaluation, and has been successfully used in the diagnosis of occult bleeding and inflammatory bowel disease [3,4]. More recently, WCE has been used to assess GI GVHD [5-7].

    • Clinical outcome of patients examined by capsule endoscopy for suspected small bowel Crohn's disease

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      As a result, diagnostic delay is common [3] and an old report found only 13% of patients with uniquely ileal disease were correctly diagnosed at the onset [4]. Since the beginning of the new millennium a swallowable video capsule that can visualise the entire small bowel mucosa has been available [5] and seems appealing in the clinical setting of suspected early CD [6]. Studies to compare the diagnostic yield of capsule endoscopy (CE) and other endoscopic and radiological means in patients with suspected or known small bowel CD have clearly shown that CE is superior when an intestinal stricture has been ruled out [7–15].

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