A Retrospective Evaluation of the Utility of Capsule Endoscopy and Double-Balloon Endoscopy in Crohn’s Disease

Masanao Nakamura,Osamu Watanabe,Kohei Funasaka,Ryoji Miyahara,Eizaburo Ohno,Hidemi Goto,Takeshi Yamamura,Hiroki Kawashima,Yoshiki Hirooka

doi:10.1155/2016/1085027

Masanao Nakamura, Osamu Watanabe + Show 7 more

Open Access

https://doi.org/10.1155/2016/1085027

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Abstract

Background. Although the usefulness of capsule endoscopy (CE) and double-balloon endoscopy (DBE) for the evaluation of Crohn's disease (CD) is established, their capabilities in the differential diagnosis of small bowel stenosis have not been sufficiently addressed. The present study therefore aimed to retrospectively determine the types of patients for whom CE and DBE would confer the most benefit. Patients and Methods. We retrospectively reviewed data from 185 patients with established CD. A change of treatment based on CE or DBE results or successful DBE balloon dilation was defined as clinically useful indication. We then analyzed the factors significantly related to useful and poor indications. Results. CE results were assessed as useful indications in 28 (45%) of 62 patients. Multivariate analysis demonstrated that positive CRP and low IOIBD score are factors significantly related to a useful indication. DBE results were recognized as useful indications in 118 (77%) of 153 patients. Multivariate analysis indicated small bowel stenosis and abdominal pain as factors significantly associated with useful indications. All patients with a poor indication on CE had small bowel stenosis. Conclusions. CE was most useful for patients in clinical remission with positive CRP and without stenosis, whereas DBE was useful for patients with symptoms of stenosis.

Highlights

Crohn’s disease (CD) is a progressive disease associated with a high risk of complications, including strictures, fistulae, perianal complications, and colorectal cancer, over time [1]
Factors related to the “Good” rating were investigated using univariate and multivariate analyses. Both approaches demonstrated that positive CRP and IOIBD score of 0 or 1 were significant factors playing a good role in assessing the effects of treatment and the status of the patient (Tables 3 and 4)
All of the patients for whom the capsule endoscopy (CE) result was in the category “Poor” had small bowel stenosis

Summary

Introduction

Crohn’s disease (CD) is a progressive disease associated with a high risk of complications, including strictures, fistulae, perianal complications, and colorectal cancer, over time [1]. Capsule endoscopy (CE) and double-balloon endoscopy (DBE) are methods used to evaluate small bowel lesions. These methods are capable of evaluating small bowel stenosis by optical observation, whether it is inflammatory or fibrotic. The use of these modalities to differentially diagnose CD with small bowel stenosis or to assess therapeutic effects has not been sufficiently investigated. The usefulness of capsule endoscopy (CE) and double-balloon endoscopy (DBE) for the evaluation of Crohn’s disease (CD) is established, their capabilities in the differential diagnosis of small bowel stenosis have not been sufficiently addressed. Multivariate analysis indicated small bowel stenosis and abdominal pain as factors significantly associated with useful indications. All patients with a poor indication on CE had small bowel stenosis. CE was most useful for patients in clinical remission with positive CRP and without stenosis, whereas DBE was useful for patients with symptoms of stenosis

Methods

Results

Conclusion