title: The role of small bowel capsule endoscopy and ileocolonoscopy in patients with nonspecific but suggestive symptoms of Crohn's disease.
abstract: OBJECTIVE
  Ileocolonoscopy (IC) and small bowel capsule endoscopy (SBCE) are essential tools in the investigation of suspected small bowel Crohn's disease (CD). Overutilization of SBCE should be avoided as it leads to unwanted healthcare expenses; thus, it is recommended when IC is normal and CD is still highly suspected. Our aim was to compare the role of SBCE and IC in the investigation of suspected CD irrespective of its location and assess the additional diagnostic benefit of SBCE over IC.
  
  
  METHODS
  This was a retrospective study of 91 patients with chronic abdominal pain and/or diarrhea. All patients were evaluated with both colonoscopy (with terminal ileum intubation where possible) and SBCE. The severity of inflammation on SBCE was assessed using the Lewis Score. Endoscopic findings were analyzed toward CD diagnosis.
  
  
  RESULTS
  The sensitivity of IC and SBCE in the diagnosis of either small bowel or colonic CD was 81.82 and 63.64%, whereas the specificity was 77.50 and 92.50%, respectively. Positive and negative predictive value was 33.33 and 96.88% for IC, as well as 53.85 and 94.87% for SBCE. Area under receiver operating characteristic curve was 0.797 for IC and 0.781 for SBCE. IC was superior to SBCE in diagnosing small and large bowel CD. SBCE showed the true extent of CD in one patient missed by IC. It identified lesions suggestive of CD in three patients with normal IC, one of whom was finally diagnosed with CD.
  
  
  CONCLUSIONS
  IC should be the initial diagnostic test in patients with nonspecific, but suggestive symptoms of CD. SBCE offers additional information on small bowel mucosa and disease extent.
authors.affiliation: Departments of aGastroenterology bInternal Medicine, School of Health Sciences, University Hospital of Ioannina, Faculty of Medicine, University of Ioannina, Ioannina, Greece cDepartment of Gastroenterology, Sackler School of Medicine, Sheba Medical Center, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Ioannis V
authors.initials: IV
authors.lastname: Mitselos
authors.forename: Dimitrios K
authors.initials: DK
authors.lastname: Christodoulou
authors.forename: Konstantinos H
authors.initials: KH
authors.lastname: Katsanos
authors.forename: Athina
authors.initials: A
authors.lastname: Tatsioni
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Rapti
authors.forename: Rami
authors.initials: R
authors.lastname: Eliakim
authors.forename: Epameinondas V
authors.initials: EV
authors.lastname: Tsianos
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology; D000328:Adult; D000368:Aged; D019540:Area Under Curve; D053704:Capsule Endoscopy; D059350:Chronic Pain / Q000175:diagnosis / Q000209:etiology; D003106:Colon / Q000473:pathology*; D003113:Colonoscopy; D003424:Crohn Disease / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D003967:Diarrhea / Q000175:diagnosis / Q000209:etiology; D005260:Female; D006801:Humans; D007082:Ileum / Q000473:pathology; D007421:Intestine, Small / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index