Utility of Wireless Capsule Enteroscopy (WCE) in Evaluating Crohn's Disease Patients with Abdominal Symptoms

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WCE is a new diagnostic modality for patients with suspected or known Crohn's disease (CD). Aim: To determine the frequency of small bowel (SB) disease and the distribution of SB lesions detected by WCE among symptomatic patients with known CD. Methods: Data of all established CD patients who underwent WCE between October 2001 and February of 2004 for symptoms suggestive of active disease were retrospectively reviewed. Symptoms included abdominal pain, gastrointestinal bleeding, diarrhea, and weight loss. All images were reviewed by a single experienced endoscopist and were analyzed with respect to type and location of SB lesions. The finding of multiple ulcerations (>3) on WCE was classified as active small bowel CD. The presence of ≤3 ulcerations was considered suggestive of active CD. Results: Ninety-seven WCE were performed on 88 symptomatic patients with documented CD. Forty-eight of 96 (50%) patients had findings diagnostic of active CD, and 10 (10%) patients had findings suggestive of active CD. Thirty-three (34%) patients had normal findings. Forty-four of 96 (46%) procedures showed lesions in more than one region of the SB. 23%, 34%, 42%, and 51% of the lesions were in the duodenum, jejunum, proximal ileum, and distal ileum, respectively. Only 5 cases showed lesions in the duodenum, jejunum, or proximal ileum without lesions in the distal ileum (Fisher's Exact p < 0.0001). The capsule reached the cecum in 64 of 96 (67%) procedures and showed active colonic ulcerations in 18 cases. Twenty-two patients had colonoscopy data within 90 days (mean 30 days) of WCE. While 55% had disease findings on WCE, only one patient (5%) had a single aphthous ulcer on colonoscopy. In 32 cases a small bowel follow through (SBFT) had been performed within 90 days of the WCE procedure (mean 30 days). WCE was superior to SBFT in detecting active Crohn's lesions (p = 0.05). Conclusion: WCE identified active SB lesions in half of CD patients experiencing abdominal symptoms. A surprisingly large number of lesions were seen in the more proximal parts of the SB, but they rarely existed in the absence of distal ileal lesions. Our limited data suggests that colonoscopy added little value to assess active disease in symptomatic patients. Therefore, WCE may be the preferred modality in evaluating CD patients presenting with symptoms. Prospective studies are needed to assess the utility of WCE as the primary tool for evaluating patients with symptomatic CD.