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Clin Gastroenterol Hepatol. 2014 Apr;12(4):609-15. doi: 10.1016/j.cgh.2013.09.028. Epub 2013 Sep 27.

Capsule endoscopy is superior to small-bowel follow-through and equivalent to ileocolonoscopy in suspected Crohn's disease.

Author information

1
Division of Gastroenterology, Mayo Clinic, Scottsdale, Arizona. Electronic address: leighton.jonathan@mayo.edu.
2
Rappaport Faculty of Medicine, Technion-Israel Institute of Technology and Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel.
3
Children Center for Digestive Health Care, Children Healthcare of Atlanta, Atlanta, Georgia.
4
Department of Gastroenterology, Skane University Hospital, Malmö, Sweden.
5
University of Massachusetts Medical School, Worcester, Massachusetts.
6
Atlanta Gastroenterology Associates, Atlanta, Georgia.
7
Johns Hopkins Hospital, Baltimore, Maryland.
8
Minnesota Gastroenterology PA, Minneapolis, Minnesota.
9
Mount Sinai School of Medicine, New York, New York.
10
Research Institute of McGill University Health Center, Montreal General Hospital, Montreal, Quebec, Canada.
11
Division of Gastroenterology, Mayo Clinic, Scottsdale, Arizona.
12
Shaare Zedek Medical Center, Jerusalem, Israel.
13
Given Imaging Ltd, Yoqneam, Israel.
14
Department of Gastroenterology, Sheba Medical Center, Tel-Aviv, Israel.

Abstract

BACKGROUND & AIMS:

Evaluation of the small intestine for inflammation has traditionally relied on small-bowel follow-through (SBFT), but multiple studies have demonstrated its low diagnostic accuracy. Capsule endoscopy (CE) transmits high-quality images of the small intestinal mucosa; it can be used to visualize the entire length of the small bowel and much of the mucosa. We compared the diagnostic yields of CE vs SBFT in a prospective study of patients with suspected small-bowel Crohn's disease.

METHODS:

Eighty patients with signs and/or symptoms of small-bowel Crohn's disease (age, 10-65 years) underwent CE, followed by SBFT and ileocolonoscopy. Readers were blinded to other test results. The primary outcome was the diagnostic yield for inflammatory lesions found with CE before ileocolonoscopy compared with SBFT and ileocolonoscopy. A secondary outcome was the incremental diagnostic yield of CE compared with ileocolonoscopy and CE compared with SBFT.

RESULTS:

The combination of CE and ileocolonoscopy detected 107 of 110 inflammatory lesions (97.3%), whereas the combination of SBFT and ileocolonoscopy detected only 63 lesions (57.3%) (P < .001). The diagnostic yield of CE compared with ileocolonoscopy was not different (P = .09). The diagnostic yield was higher for CE than for SBFT (P < .001). Of the 80 patients with suspected Crohn's disease, 25 (31.3%) had the diagnosis confirmed. Eleven were diagnosed by CE findings alone and 5 by ileocolonoscopy findings alone. In the remaining 9 patients, diagnostic findings were identified by at least 2 of the 3 modalities. No diagnoses were made on the basis of SBFT findings alone.

CONCLUSIONS:

CE was better than SBFT and equivalent to ileocolonoscopy in detecting small-bowel inflammation. Although ileocolonoscopy remains the initial diagnostic test of choice, CE is safe and can establish the diagnosis of Crohn's disease in patients when ileocolonoscopy results are negative or the terminal ileum cannot be evaluated. ClinicalTrials.gov Number: NCT00487396.

KEYWORDS:

Diagnostic Techniques and Procedures; Digestive System; Gastrointestinal Tract; Radiology

PMID:
24075891
DOI:
10.1016/j.cgh.2013.09.028
[Indexed for MEDLINE]
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