SMALL-BOWEL CAPSULE ENDOSCOPY IN INFLAMMATORY BOWEL DISEASE TYPE UNCLASSIFIED

Abstract

Abstract Background and aim Ulcerative colitis (UC) and Crohn’s disease (CD) are idiopathic inflammatory bowel diseases (IBD) with no unique, gold standard diagnostic test. UC and Crohn’s colitis are in approximately 10% of cases impossible to be distinguished. The term IBD type unclassified (IBD-U) is officially proposed for the cases of chronic colitis showing overlapping endoscopic, radiological, and biopsy histological features between UC and CD, while indetermined colitis is reserved for colectomy specimen. Our aim was to evaluate the role of small-bowel capsule endoscopy (SBCE) in the diagnostic work-up of IBD-U. Material and methods We prospectively studied all cases of IBD-U explored by SBCE in our tertiary referral gastroenterology center. Patients were investigated by SBCE after contraindications were excluded. Diagnostic criteria for small bowel CD consisted in more than 3 ulcerations, irregular ulcers or stenosis; if fulfilled, Crohn’s colitis was sustained. The absence of CD features in the small bowel (SB) strengthened the assumption of UC. Follow-up data were recorded. Results Fifteen patients with IBD-U were explored by SBCE. Seven patients had SB lesions meeting the diagnostic criteria for CD. The remaining eight examinations showed no SB significant findings; therefore, they were classified as UC. No complications occurred. The patients were treated accordingly. Follow-up data recorded a case of colectomy for refractory UC. Conclusions SBCE is a useful safe tool in the management of IBD unclassified. Due to its diagnostic valences, SBCE plays a particular role in the process of proper clinical decision-making.