The value of capsule endoscopy in the diagnosis and management of Crohn's disease: report of two cases

Role of capsule endoscopy in inflammatory bowel disease: where we are and where we are going

Capsule endoscopy (CE) is an innovative technological breakthrough that for the first time provides a noninvasive method to obtain high-resolution imaging of the entire small bowel. Since its recent inception, the diagnostic utility of CE has become well established for the evaluation of diverse ulcerative and inflammatory disorders of the jejunum and ileum. The incredible resolution of its lens (0.1 mm) detects focal villous edema or atrophy, denuded, as well as ulcerated mucosal lesions missed by other imaging techniques. CE has been shown by meta-analysis to be a more sensitive method to investigate patients for small bowel Crohn's disease, with an incremental yield above 30% versus other imaging modalities. In patients with indeterminate colitis, CE is useful in distinguishing between ulcerative and Crohn's colitis. Among patients with established Crohn's disease, CE may be employed to determine: (1) the extent and severity of small bowel involvement, (2) postoperative recurrence, (3) post-therapy mucosal healing, and (4) whether active small bowel inflammatory lesions exist in the clinical setting of functional bowel disorder. Complications are rare and include capsule retention at stricture sites. The new patency capsule can diminish the risk of the latter problem in at-risk patients. CE can also serve as a guide to sites that require biopsies or dilatation by push or double-balloon enteroscopy. However, other causes of small bowel lesions may mimic Crohn's disease. A standard terminology system has thus been developed, and a CE Crohn's disease severity scoring index is currently undergoing validation studies.

Evolving diagnostic modalities in inflammatory bowel disease

Over the past several years, significant advances have been made in the diagnostic techniques used in the management of ulcerative colitis and Crohn's disease. These advances have occurred mainly in the area of gastrointestinal endoscopy and radiology. Capsule endoscopy and double-balloon endoscopy have permitted better visualization of the small bowel mucosa. Advanced imaging techniques, including chromoendoscopy, magnification endoscopy, confocal endomicroscopy, and spectroscopy, may aid in the diagnosis of colorectal neoplasia in patients with long-standing disease. Improved radiographic imaging techniques based on computed tomography and magnetic resonance imaging allow noninvasive means of evaluating the small bowel in patients with known or suspected Crohn's disease. Finally, positron emission tomography is an investigative tool for inflammatory bowel disease that may also aid in the detection of inflammation in these diseases.

Frequency and clinical outcome of capsule retention during capsule endoscopy for GI bleeding of obscure origin

BACKGROUND

Capsule endoscopy is now commonly performed for GI bleeding of obscure origin. Regional transit abnormality refers to slowed capsule movement during capsule endoscopy. The frequency and clinical outcome of capsule retention and regional transit abnormalities are unknown.

METHODS

Initial capsule endoscopies performed at a single institution in 52 patients with GI bleeding of obscure origin were reviewed retrospectively. For patients with capsule retention or regional transit abnormality, preprocedural characteristics, and post-procedural outcomes were recorded.

OBSERVATIONS

Capsule retention occurred in 7 patients, all of whom remained asymptomatic. Regional transit abnormality was noted in 3 patients. Sources of bleeding were localized in all cases. Seven patients underwent surgery. Stricture induced by non-steroidal anti-inflammatory drugs was the major cause of retention. In all patients, anemia resolved during follow-up.

CONCLUSIONS

Capsule retention and regional transit abnormality occurred in almost 20% of patients who had capsule endoscopy for GI bleeding of obscure origin. These capsule movement abnormalities led to the diagnosis of bleeding sources and thereby influenced patient management. A history of non-steroidal anti-inflammatory drugs use may be associated with an increased risk of capsule retention.