Initial experience with wireless capsule enteroscopy in the diagnosis and management of inflammatory bowel disease.
OBJECTIVE
Wireless capsule enteroscopy (WCE) offers the potential to directly visualize the entire small bowel and identify superficial lesions not detected by traditional endoscopy and radiography. The aim of this study is to assess the clinical utility of WCE in the evaluation of patients with known or suspected inflammatory bowel disease (IBD).


METHODS
Fifty patients with ongoing symptoms underwent Given M2A endoscopic capsule examinations. Indications included: (1) evaluation for small-bowel involvement in patients with IBD with isolated colitis (n = 22), (2) determination of the extent of small-bowel disease in patients with Crohn's disease (CD; n = 20), and (3) workup of suspected IBD (n = 8). Outcome measures were classified as diagnostic when multiple ulcerations were present, suspicious when </=3 ulcerations were seen, and nonspecific or normal.


RESULTS
WCE findings were diagnostic for CD in 20 patients and suspicious for small-bowel CD in 10 patients. Seventeen of 20 patients with diagnostic WCE findings improved with increased IBD-directed medical therapy, as did 7 of 10 patients with suspicious study results. WCE was normal or showed nonspecific findings in the remaining 20 patients. Notably, identification of small-bowel lesions in 5 patients with a previous history of isolated colitis resulted in a change in diagnosis to CD after confirmatory ileoscopy with biopsy.


CONCLUSIONS
Results of this preliminary study suggest that WCE is a novel and potentially clinically useful method of directly visualizing and diagnosing small-bowel lesions in patients with IBD that can be missed by traditional endoscopic and radiological procedures.
Mow
William S
WS
Inflammatory Bowel Disease Center, Los Angeles, California, USA.
Lo
Simon K
SK
Targan
Stephan R
SR
Dubinsky
Marla C
MC
Treyzon
Leo
L
Abreu-Martin
Maria T
MT
Papadakis
Konstantinos A
KA
Vasiliauskas
Eric A
EA
D000293:Adolescent; D000328:Adult; D000368:Aged; D002214:Capsules; D003093:Colitis, Ulcerative / Q000175:diagnosis; D003424:Crohn Disease / Q000175:diagnosis; D019468:Disease Management; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D015212:Inflammatory Bowel Diseases / Q000145:classification / Q000175:diagnosis*; D007413:Intestinal Mucosa / Q000000981:diagnostic imaging / Q000473:pathology; D007421:Intestine, Small / Q000000981:diagnostic imaging / Q000473:pathology; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional; D012189:Retrospective Studies; D012720:Severity of Illness Index
D002214:Capsules