Wireless capsule endoscopy versus ileocolonoscopy for the diagnosis of post-operative recurrence of Crohn's disease: a prospective study

Arnaud Bourreille ¹, Marine Jarry ², Pierre-Nicolas D'Halluin ³, Emmanuel Ben-Soussan ⁴, Vincent Maunoury ², Philippe Bulois ², Sylvie Sacher-Huvelin ⁵, Kouroche Vahedy ⁶, Eric Lerebours ⁴, Denis Heresbach ³, Jean-François Bretagne ³, Jean-Frederic Colombel ^2* and Jean-Paul Galmiche ¹

¹ University Hospital Nantes, France
² University Hospital Lille, France
³ University Hospital Rennes, France
⁴ University Hospital Rouen, France
⁵ Centre d'Investigation Clinique INSERM, France
⁶ University Hospital Paris, France

^* To whom correspondence should be addressed. E-mail: jfcolombel{at}chru-lille.fr.

Accepted 10 December 2005

Abstract

Background and aims: Following ileocolonic resection for Crohn's disease (CD), early endoscopic recurrence predicts the recurrence of symptoms. The aim of the study was to compare ileocolonoscopy and wireless capsule endoscopy (WCE) for the detection of post- operative recurrence in CD.

Methods: WCE and ileocolonoscopy were performed within 6 months following surgery in 32 prospectively enrolled patients. Two independent observers interpreted the results of WCE. Recurrence in the neoterminal ileum was defined by a Rutgeerts' score 1. When observers at WCE were did not concur, WCE results were considered either as true negative or true positive and sensitivity (Se) and specificity (Sp) were calculated according to both assumptions.

Results: Recurrence occurred in 21 patients (68%) and was detected by ileocolonoscopy in 19 patients. Its sensitivity (Se) was 90% and its specificity (Sp) 100%. The Se of WCE was 62% and 76% and the Sp was 100% and 90% respectively depending of assumptions. There was a correlation between the severity of the lesions measured by both methods (p < 0.05). Lesions located outside the scope of conventional endoscopy were detected by WCE in two-thirds of the patients with an excellent inter- observer agreement (kappa > 0.9) for all lesions with the exception of ulceration (kappa = 0.7).

Conclusions: The sensitivity of WCE to detect recurrence is the neoterminal ileum was inferior to that of ileocolonoscopy. On the other hand, WCE detected lesions in the jejunum and the ileum in more than 2/3 of patients. Additional follow-up studies are needed to assess the clinical relevance of such lesions. At the present time, it seems that WCE cannot systematically replace ileocolonoscopy in the regular management of patients after surgery.

Keywords: Crohn's disease, capsule, endoscopy, inflammatory bowel disease, wireless capsule endoscopy

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