Wireless Capsule Enteroscopy: A Comparison with Enterography, Push Enteroscopy and Ileo-colonoscopy in the Diagnosis of Small Bowel Crohn's Disease

Abstract

Background: Conventional radiological and endoscopic imaging methods of the small bowel (SB) have several limitations, which often delays diagnosis and adequate treatment of small bowel Crohn's disease (SBCD). The recent introduction of Given M2A capsule enteroscopy (CE) may change this scenario, by enabling direct visualization of the entire SB mucosa. Objective: To evaluate the diagnostic value of CE, versus barium enterography (BE), push enteroscopy (PE) and ileo-colonoscopy (IC) in SBCD. Patients and methods: 53 consecutive patients (40 women and 13 men, mean age 36 years, range 14-62), with clinically suspected active CD were included in a prospective, controlled study. Eligible patients had either suspected (61%), based on predefined clinical and biochemical markers, or previously diagnosed CD (39%). Five patients with SB stricture detected on BE and one patient with ischemic enteropathy were excluded from the study. 47 patients completed all 4 examinations, i.e. standard BE (89% enteroclysis, 11% SB follow through), IC, PE and CE were evaluated. All examinations were performed within 3 months by experienced investigators. Results: Crohn's lesions (multiple erosions, ulcerations and/or strictures) in the SB were visualized by one or more methods in 25 (53%) of the 47 patients. All cases with SBCD detected on BE, PE and IC were also identified using CE except 3 (12%) cases where the capsule did not pass through the entire SB during the examination. Notably, CE identified 4 additional patients with CD and detected more extended SBCD in 6 (24%) patients compared to the other methods. Intubation of ileum was unsuccessful in 3 (12%) cases examined by IC. All examinations were performed without complications. The capsule was easily swallowed by all patients and was expelled without side effects. CE was preferred to BE by 95% of patients. Sensitivity and specificity of the studied methods for detecting SBCD are showed in the table. Conclusions: CE is a safe, well-tolerated and more sensitive imaging modality for visualizing Crohn's lesions in the entire SB compared with BE, PE and IC. Our data suggest that capsule endoscopy may be considered as a first line imaging examination in patients with suspected, non-stricturing small bowel Crohn's disease.