Capsule endoscopy is superior to small-bowel follow-through and equivalent to ileocolonoscopy in suspected Crohn's disease.
OBJECTIVE
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.
Division of Gastroenterology, Mayo Clinic, Scottsdale, Arizona. Electronic address: leighton.jonathan@mayo.edu.
Jonathan A
JA
Leighton
Rappaport Faculty of Medicine, Technion-Israel Institute of Technology and Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel.
Ian M
IM
Gralnek
Children Center for Digestive Health Care, Children Healthcare of Atlanta, Atlanta, Georgia.
Stanley A
SA
Cohen
Department of Gastroenterology, Skane University Hospital, Malmö, Sweden.
Ervin
E
Toth
University of Massachusetts Medical School, Worcester, Massachusetts.
David R
DR
Cave
Atlanta Gastroenterology Associates, Atlanta, Georgia.
Douglas C
DC
Wolf
Johns Hopkins Hospital, Baltimore, Maryland.
Gerard E
GE
Mullin
Minnesota Gastroenterology PA, Minneapolis, Minnesota.
Scott R
SR
Ketover
Mount Sinai School of Medicine, New York, New York.
Peter E
PE
Legnani
Research Institute of McGill University Health Center, Montreal General Hospital, Montreal, Quebec, Canada.
Ernest G
EG
Seidman
Division of Gastroenterology, Mayo Clinic, Scottsdale, Arizona.
Michael D
MD
Crowell
Shaare Zedek Medical Center, Jerusalem, Israel.
Ari J
AJ
Bergwerk
Given Imaging Ltd, Yoqneam, Israel.
Ravit
R
Peled
Department of Gastroenterology, Sheba Medical Center, Tel-Aviv, Israel.
Rami
R
Eliakim
D000293:Adolescent; D000328:Adult; D000368:Aged; D053704:Capsule Endoscopy / Q000379:methods*; D002648:Child; D003424:Crohn Disease / Q000175:diagnosis* / Q000473:pathology*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006801:Humans; D007421:Intestine, Small / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055815:Young Adult
Diagnostic Techniques and Procedures; Digestive System; Gastrointestinal Tract; Radiology