Utility of Capsule Endoscopy for the Diagnosis and Classification of Crohn's Disease: A Multicenter Study in a Low Incidence Country, South Korea

Abstract

A capsule endoscopy (CE) can detect the lesions associated with Crohn's disease in the small bowel that go unrecognized by conventional radiologic and endoscopic imaging. The detection of such lesions by CE can alter the clinical management. The aim of this study was to assess the value of CE in the diagnosis and classification of patients with Crohn's disease. Methods: This study was carried out from September 2002 until June 2004 at 12 institutions (Gut Image Study Group) on 50 patients, comprising 23 patients with known Crohn's disease and 27 out of 37 patients suspected of having Crohn's disease, were diagnosed with Crohn's disease according to CE. Small bowel follow through (SBFT) findings were compared with the CE findings. All the patients were classified according to the extent of the disease: small bowel-colon type, small bowel type, colon type. Results: The findings detected by CE were 29 mucosal erosions, 34 aphthous ulcers, 32 longitudinal or irregular ulcers, 5 cobblestone appearances, and 12 strictures. The distribution of the lesions was mainly in the distal part of small bowel (distal jejunum, ileum), which could not be reached by push enteroscopy and colonoscopy. All were classified into 25 small bowel-colon types, 23 small bowel types, and 2 colon types according to the extent of the disease. In the small bowel type, the small bowel lesion detection rate by colonoscopy was 39% (9/23). Forty-one of the 50 patients had undergone SBFT. Of the 41 SBFT patients, 27 patients (56%), who were reported as being normal, showed evidence of small bowel Crohn's disease according to CE. The sensitivity of SBFT was 41%. Differences were observed between the SBFT and CE classification. The patients were classified into 17 small bowel-colon types, 13 small bowel types, 5 colon types, and 6 normal findings according to the SBFT, in contrast 20 small bowel-colon types, 19 small bowel types, and 2 colon types according to CE. CE provided evidence of a great deal more small bowel involvement than observed on SBFT and colonoscopy. Conclusions: CE is a valuable diagnostic tool for patients with suspected of having Crohn's disease, which has not been confirmed by traditional radiography and colonoscopy. It can also be used to classify known Crohn's disease.