Diagnosing Crohn's Disease (CD) of the Small Bowel (SB): Should Capsule Endoscopy (CE) Be Used? CE vs. Other Diagnostic Modalities

Abstract

AIM: To evaluate the ability of different diagnostic modalities (SB series, CE, ileo/colonoscopy and histopathology of the terminal ileum (TI) to detect SB abnormalities consistent with CD. METHODS: Prospective comparison of SB series vs. CE vs. ileo/colonoscopy with TI histopathology among 40 patients with known/suspected active CD of the SB. Ileo/colonoscopy with TI histopathology followed by SB series are performed within 4 weeks prior to CE. Patients with SB strictures identified on SB series are excluded from the study. RESULTS: This is an ongoing study. 31 patients were evaluated (23, known CD/recurrence- 18 of them had a previous SB resection; 8, suspected CD). No complications occurred. CE identified 24 (77.4%) positive findings suggestive of CD in the SB, ileo/colonoscopy 14 (45.1%), TI histopathology 13 (41.9%) and SB series 5 (16.1%). SB findings consistent with CD were detected by CE in 20 patients with CD recurrence and in 4 patients with suspected CD (2 confirmed by TI histopathology). CE showed CD positive findings in the proximal SB in 7 patients while all three other tests were negative. Fisher's exact test was used to compare the respective proportions of detected positive findings suggestive of CD in the SB between conventional- ileo/colonoscopy with SB series 15 (48.4%)and alternative- ileo/colonoscopy with CE 24 (77.4%) diagnostic approach. The difference was statistically significant (P<0.034). CONCLUSIONS: The diagnostic accuracy of SB series for detection early inflammatory changes of the SB mucosa consistent with CD was poor compared with CE, ileo/colonoscopy and TI histopathology. CE appeared more likely to detect SB lesions proximal to TI than other modalities. This suggests a new diagnostic strategy integrating CE with ileo/colonoscopy as a first line investigation in patients with non-stricturing CD of the SB. However further comparative trials are needed to confirm these results and demonstrate if this approach is justified.