Abstract
Background. The aim of this work was to assess the value of capsule enteroscopy in the diagnosis of patients with suspected Crohn's Disease (CD). Methods. This was a retrospective study in a single tertiary care centre involving patients undergoing capsule enteroscopy for suspected CD. Patients taking nonsteroidal anti inflammatory drugs during the thirty preceding days or with a follow-up period of less than six months were excluded. Results. Seventy eight patients were included. The endoscopic findings included mucosal breaks in 50%, ulcerated stenosis in 5%, and villous atrophy in 4%. The diagnosis of CD was established in 31 patients. The sensitivity, specificity, positive and negative predictive value of the endoscopic findings were 93%, 80%, 77%, and 94%, respectively. Capsule retention occurred in four patients (5%). The presence of ulcerated stenosis was significantly more frequent in patients with positive inflammatory markers. The diagnostic yield of capsule enteroscopy in patients with negative ileoscopy was 56%, with a diagnostic acuity of 93%. Conclusions. Small bowel capsule endoscopy is a safe and valid technique for assessing patients with suspected CD. Capsule retention is more frequent in patients with positive inflammatory markers. Patients with negative ileoscopy and suspected CD should be submitted to capsule enteroscopy.
Highlights
The current view is that the diagnosis of Crohn’s Disease (CD) is established by a combination, not strictly defined, of clinical presentation, endoscopic appearance, radiology, histology, surgical findings, and, more recently, serology [1].The role of small-bowel capsule endoscopy (SBCE) in this context is still debateable [2], namely, because the concept of suspected CD, with implications in the selection of the patients, is itself under discussion
Between January 2001 and December 2007, 95 patients clinically suspected of having CD underwent capsule enteroscopy
The sensitivity and, above all, the high negative predictive value and low negative likelihood ratio, suggesting the high probability of absence of the illness in patients who do not show endoscopic lesions, are, in our opinion, the most relevant piece of information to emerge from the study
Summary
The current view is that the diagnosis of Crohn’s Disease (CD) is established by a combination, not strictly defined, of clinical presentation, endoscopic appearance, radiology, histology, surgical findings, and, more recently, serology [1].The role of small-bowel capsule endoscopy (SBCE) in this context is still debateable [2], namely, because the concept of suspected CD, with implications in the selection of the patients, is itself under discussion. Even though lesions such as aphthae, erosions, or ulcers may be considered suggestive of the existence of the disease, the fact is that other aetiologies, namely, the use of nonsteroidal antiinflammatory drugs (NSAIDs) may be associated with the presence of these lesions, not forgetting the fact that healthy adults with no history of ingesting pharmaceutical drugs may present similar lesions [3]. Patients with negative ileoscopy and suspected CD should be submitted to capsule enteroscopy
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