The diagnosis of small-bowel Crohn's disease sometimes is difficult and may be missed by conventional imaging studies. Capsule endoscopy might identify small-bowel disease undetected by other investigations.
Methods
Patients with or without known Crohn's disease who were suspected to have small-bowel Crohn's disease were prospectively evaluated with push enteroscopy, enteroclysis, and capsule endoscopy. Each examiner was blinded to results of other investigations. Referring doctors were required to complete questionnaires before and after the investigations.
Results
Twenty-two patients were known to have Crohn's disease (Group 1), and 21 were suspected to have small-bowel Crohn's disease (Group 2). In Group 1, capsule endoscopy detected more erosions than the other two investigations (p < 0.001). In Group 2, a new diagnosis of Crohn's disease was made in two patients, but there was no significant difference in yield compared with the other two investigations. Referring physicians rated the usefulness of capsule endoscopy as 4.4 on a scale of 5. Capsule endoscopy changed management for 30 patients (70%).
Conclusions
Capsule endoscopy has a higher yield than push enteroscopy and enteroclysis in patients with known Crohn's disease when small-bowel mucosal disease is suspected, and this leads to a change in management in the majority of these patients.
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Patients and methods
This was a prospective, blinded, comparative study performed at single tertiary referral hospital. Patients with or without a prior diagnosis of Crohn's disease who were suspected to have small-bowel Crohn's disease were eligible. The clinical suspicion was based on symptoms with or without elevated levels of biochemical markers or radiographic findings (Table 1). The study was advertised at major hospitals in Melbourne to gastroenterologists with an interest in inflammatory bowel disease.
Results
Forty-five eligible patients were identified from May 2002 to November 2003. Two were excluded: one had a stricture detected on enteroclysis, and the other required abdominal surgery for an unrelated problem after enteroclysis and did not undergo capsule endoscopy. Twenty-two patients were known to have Crohn's disease (Group 1); for 21 patients, there was no prior diagnosis of Crohn's disease (Group 2). Patient characteristics are summarized in Table 1. For the two groups, data are analyzed
Discussion
Capsule endoscopy detected the presence and the extent of small-bowel Crohn's disease missed by other investigations, including push enteroscopy and enteroclysis. It detected small-bowel Crohn's disease in 17 (77%) patients in Group 1 and two (10%) in Group 2. These results suggest that capsule endoscopy should be considered when the clinical suspicion of small-bowel Crohn's disease is high and other first-line investigations, including upper endoscopy, colonoscopy, and barium contrast studies,
2017, Biomechanics of Living Organs: Hyperelastic Constitutive Laws for Finite Element Modeling
In the United States diseases of the gastrointestinal tract affect over 60 million people and generate a financial burden exceeding $140 billion per year. Capsule endoscopes that can be swallowed by the patients have been designed to image and biopsy the small intestine, which cannot be otherwise reached with traditional endoscopes. We measured the mechanical properties of the small intestine and developed a computational platform that simulates the response of the intestinal tissue under the mechanical loads imposed by capsule endoscopes. This platform represents a valuable tool in the design and optimization of endoscopes and surgical devices that interact with the small intestine.
Clinical management was changed in 9% and 39% of patients diagnosed with push enteroscopy and WCE, respectively.39,40,58 In 2 series, all lesions diagnosed by push enteroscopy were also seen by WCE, but most of the lesions seen by WCE and not by push enteroscopy were distal to the reach of the enteroscope.39,58 However, in a study of patients with familial adenomatous polyposis, push enteroscopy detected many more polyps than WCE, even though the latter examined far more of the intestine.
2012, Best Practice and Research: Clinical Gastroenterology
Citation Excerpt :
SBCE and MRE had similar sensitivities and specificities. The meta-analysis by Dionisio and colleagues [38] included two studies comparing SBCE with PE [48,49] and eight studies comparing SBCE with IC [39,41,49–54]. When compared with PE, SBCE had an overall IYw of 42%.
The last decade has witnessed a revolution in small bowel (SB) endoscopy technologies. Endoscopists are no longer confined to the use of push enteroscopy or the significantly more invasive intra-operative enteroscopy: SB capsule endoscopy (SBCE) and device assisted enteroscopy (DAE) have rapidly enabled endoscopic visualisation of the entire SB without the need for surgery. DAE goes a step further by allowing tissue sampling and the application of endotherapy. These developments have also been parallelled by rapid advances in dedicated radiological SB imaging technologies. Although it is clear that SBCE and DAE may have a significant role in the diagnosis and management of IBD patients, their respective place in relation to other technologies within the clinical paradigm of IBD is as yet unclear. This review outlines the current evidence base relating to these endoscopic technologies and their impact in the diagnosis and management of IBD and highlights current international recommendations.
