Abstract

BackgroundCrohn’s disease (CD) can involve the upper gastrointestinal (GI) tract as well as the small and large bowel. PillCam colon capsule endoscopy (PCCE-2) enables observation of the whole GI tract, but its diagnostic yield for CD lesions in the whole GI tract remains unknown.AimTo elucidate the diagnostic yield of PCCE-2 in patients with CD.MethodsPatients with CD who underwent PCCE-2 and double-balloon endoscopy (DBE) using oral and anal approaches were evaluated for CD lesions in the whole GI tract. We divided the small bowel into three segments (jejunum, ileum, and terminal ileum), and the large bowel into four segments (right colon, transverse colon, left colon, rectum). Detection of ulcer scars, erosion, ulcers, bamboo joint-like appearance, and notch-like appearance was assessed in each segment. The diagnostic yield of PCCE-2 was analyzed based on the DBE results as the gold standard.ResultsOf the total 124 segments, the sensitivities of PCCE-2 for ulcer scars, erosion, and ulcers were 83.3%, 93.8%, and 88.5%, respectively, and the specificities were 76.0%, 78.3%, and 81.6%, respectively. For the 60 small bowel segments, the sensitivities were 84.2%, 95.5%, and 90.0%, respectively, and the specificities were 63.4%, 86.8%, and 87.5%, respectively. For the 64 large bowel segments, the sensitivities were 80.0%, 90.0%, and 83.3%, respectively, and the specificities were 84.7%, 72.2%, and 77.6%, respectively.ConclusionPCCE-2 provides a high diagnostic yield for lesions in the whole GI tract of patients with CD. Thus, we recommend its use as a pan-enteric tool in clinical settings.

Highlights

  • Crohn’s disease (CD) is a chronic inflammatory bowel disease (IBD) that mainly involves the small and large bowel

  • The primary endpoint of this study was the diagnostic yield of PCCE-2 for erosive lesions in each segment, and the secondary endpoints were the evaluation of CD activity using PCCE-2 and clinical results of PCCE-2 including retention of capsule

  • Small bowel obstruction was suspected in one patient, and patency was not confirmed by patency capsule (PC) in another patient

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Summary

Introduction

Crohn’s disease (CD) is a chronic inflammatory bowel disease (IBD) that mainly involves the small and large bowel. The second-generation PillCam colon capsule endoscope (PCCE-2; Medtronic Co. Ltd., Dublin, Ireland) has been developed and can be used to examine the whole GI tract, including the small and large bowel, it was originally designed as a tool to diagnose colorectal lesions [6]. Some studies confirmed the safety and feasibility of PCCE-2 as a pan-enteric tool for patients with CD [6, 13], the diagnostic yield of PCCE-2 for the whole GI CD lesions remains unknown. Balloon-assisted enteroscopy, such as double-balloon endoscopy (DBE) and single-balloon endoscopy (SBE), has been shown to have a high diagnostic yield in detecting small bowel diseases [14]. PillCam colon capsule endoscopy (PCCE-2) enables observation of the whole GI tract, but its diagnostic yield for CD lesions in the whole GI tract remains unknown

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