The Role of Video Capsule Endoscopy in Patients with Suspected Small Bowel Crohnʼs Disease Despite a Normal Ileoscopy

Abstract

Purpose: To evaluate the benefit of performing video capsule endoscopy (VCE) in patients with suspected Crohn's Disease of the small bowel (SB-CD) despite a normal exam of the ileum on colonoscopy. Methods: We prospectively recorded the findings of patients who have undergone both a colonoscopy (CLN) with exam of the terminal ileum and a VCE for the evaluation of suspected SB-CD at our institution between January 2006 and March 2008. Positive findings on ileoscopy and VCE suggestive of CD included the presence of ulcers, erosions, inflammatory polyps, and inflammatory strictures. Isolated erythema was considered a normal finding in this study. NSAIDs use was recorded. Results: A total of 47 patients with suspected SB-CD underwent CLN with ileoscopy and VCE. 30 patients were female and 17 patients were male, with a mean age of 38 years. Patient's symptoms included abdominal pain, blood in the stool, and diarrhea. Ileoscopy was normal in 35 patients (74.5%) and abnormal in 12 patients (25.5%). VCE was normal in 34 patients (72.3%) and abnormal in 13 patients (27.7%). VCE was abnormal in 5 of the 35 patients with normal ileoscopy (14.3%). All 5 patients in this subset had ulcers and/or erosions in the proximal and mid-small bowel. None of these patients had reported NSAID use. The VCE was normal in 4 of the 12 patients with ileal ulcers on CLN, but it detected proximal and mid-SB ulcers in the remaining 8 patients. Conclusion: VCE is a valuable tool for the diagnosis of SB-CD and the evaluation of the extent of SB involvement with CD in a subset of patients whose diagnosis would have been missed if it was solely based on a normal exam of the ileum on colonoscopy.