Alimentary Tract
Wireless capsule video endoscopy compared to barium follow-through and computerised tomography in patients with suspected Crohn’s disease—final report

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Abstract

Background. Wireless capsule endoscopy is a superior diagnostic tool to barium small bowel follow-through and enteroscopy in diagnosing patients with occult blood loss.

Aim. To compare capsule endoscopy with barium follow-through and entero-computerised tomography in patients with suspected Crohn’s disease.

Subjects and methods. Thirty-five patients with suspected Crohn’s disease underwent the three examinations. The radiologist and gastroenterologist were blinded to each other’s results. In cases of discrepancy, colonoscopy and ileoscopy were performed.

Results. Thirty-five patients (22 males), mean age 28.4 years, were included. Eighty-eight percent had abdominal pain, 83% had diarrhoea and 69% had weight loss. The diagnostic yield of capsule endoscopy was 77% versus 23% and 20% of barium and computerised tomography examinations, respectively (P<0.05). The capsule detected all of the lesions diagnosed by barium follow-through and entero-computerised tomography.

Conclusions. Capsule endoscopy is a superior and more sensitive diagnostic tool than barium follow-through and entero-computerised tomography in patients with suspected Crohn’s disease.

Introduction

Diagnosing early Crohn’s disease can be difficult as barium small bowel series, the most commonly used procedure, may give a negative result. The terminal ileum is accessible otherwise only via conventional colonoscopy, and this is unsuccessful on many occasions. The yield of small bowel follow-through to demonstrate the extent and severity of small bowel Crohn’s disease varies from a significantly low result [1], [2], [3] to a very good result with a sensitivity of 90% and a specificity of 96% [4], [5].

Computerised tomography (CT) has the ability to directly observe the bowel wall, adjacent abdominal organs, mesentery and retroperitoneum, enabling the diagnosis of most severe complications of Crohn’s disease [6]. CT’s role in early-undiagnosed Crohn’s disease remains to be determined.

The small bowel is the most difficult part to examine endoscopically because of its length. Recently, a wireless capsule endoscope has been developed and is now available for clinical practice [7]. The capsule has demonstrated superiority to push enteroscopy in detecting small bowel abnormalities in patients with suspected small bowel bleeding [8], [9].

Three studies found capsule endoscopy to be superior to small bowel follow-through in patients with Crohn’s disease [10], [11], [12], two of which were not prospective.

The present study compares prospectively capsule endoscopy to small bowel follow-through and entero-computerised tomography (entero-CT) as diagnostic tools in patients with suspected Crohn’s disease. It is the extended, final report (35 patients) of our initial study (20 patients) published earlier [10].

Section snippets

Subjects and methods

Thirty-five patients with chronic diarrhoea and/or recurrent abdominal pain and/or weight loss were referred by either family practitioners or gastroenterologists to our out-patient clinic and were enrolled in the study. Patients with a prior history of bowel obstruction, major abdominal surgery, diabetes mellitus, cardiac pacemaker or any mental condition that precludes compliance or pregnant women or patients taking NSAIDS were excluded from the study. All patients signed a written informed

Results

Thirty-five consecutive patients completed the study. There were 22 males and 13 females, their mean age being 28.4 years (range from 19 to 57 years). Seven were noted as thin, and mean weight of all 35 patients was 67 kg (range 48–112 kg). Eighty-nine percent of patients had abdominal pain, 83% had diarrhoea and 69% had weight loss, which was significant in 45% of them. There was no evidence of gastrointestinal bleeding in any of the patients. The 35 patients underwent 95 procedures prior to

Discussion

Up till recently, the diagnosis of small bowel Crohn’s disease relied on either barium follow-through, enteroclysis or, when successful, ileoscopy.

In the National Cooperative Crohn’s Disease study, the authors concluded that the barium follow-through of the small intestine failed to demonstrate the extent and severity of Crohn’s disease in a significant number of patients [1]. The study was carried out at 14 university hospital centres probably reflecting the average level of radiographic

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