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Capsule Endoscopy Is Superior to Small-bowel Follow-through and Equivalent to Ileocolonoscopy in Suspected Crohn's Disease

Leighton, Jonathan A.; Gralnek, Ian M.; Cohen, Stanley A.; Toth, Ervin LU ; Cave, David R.; Wolf, Douglas C.; Mullin, Gerard E.; Ketover, Scott R.; Legnani, Peter E. and Seidman, Ernest G., et al. (2014) In Clinical Gastroenterology and Hepatology 12(4). p.609-615
Abstract
BACKGROUND & AIMS: Evaluation of the small intestine for inflammation has traditionally relied on small-bowel follow-through (SBFT), but multiple studies have demonstrated its low diagnostic accuracy. Capsule endoscopy (CE) transmits high-quality images of the small intestinal mucosa; it can be used to visualize the entire length of the small bowel and much of the mucosa. We compared the diagnostic yields of CE vs SBFT in a prospective study of patients with suspected small-bowel Crohn's disease. METHODS: Eighty patients with signs and/or symptoms of small-bowel Crohn's disease (age, 10-65 years) underwent CE, followed by SBFT and ileocolonoscopy. Readers were blinded to other test results. The primary outcome was the diagnostic yield... (More)
BACKGROUND & AIMS: Evaluation of the small intestine for inflammation has traditionally relied on small-bowel follow-through (SBFT), but multiple studies have demonstrated its low diagnostic accuracy. Capsule endoscopy (CE) transmits high-quality images of the small intestinal mucosa; it can be used to visualize the entire length of the small bowel and much of the mucosa. We compared the diagnostic yields of CE vs SBFT in a prospective study of patients with suspected small-bowel Crohn's disease. METHODS: Eighty patients with signs and/or symptoms of small-bowel Crohn's disease (age, 10-65 years) underwent CE, followed by SBFT and ileocolonoscopy. Readers were blinded to other test results. The primary outcome was the diagnostic yield for inflammatory lesions found with CE before ileocolonoscopy compared with SBFT and ileocolonoscopy. A secondary outcome was the incremental diagnostic yield of CE compared with ileocolonoscopy and CE compared with SBFT. RESULTS: The combination of CE and ileocolonoscopy detected 107 of 110 inflammatory lesions (97.3%), whereas the combination of SBFT and ileocolonoscopy detected only 63 lesions (57.3%) (P < .001). The diagnostic yield of CE compared with ileocolonoscopy was not different (P = .09). The diagnostic yield was higher for CE than for SBFT (P < .001). Of the 80 patients with suspected Crohn's disease, 25 (31.3%) had the diagnosis confirmed. Eleven were diagnosed by CE findings alone and 5 by ileocolonoscopy findings alone. In the remaining 9 patients, diagnostic findings were identified by at least 2 of the 3 modalities. No diagnoses were made on the basis of SBFT findings alone. CONCLUSIONS: CE was better than SBFT and equivalent to ileocolonoscopy in detecting small-bowel inflammation. Although ileocolonoscopy remains the initial diagnostic test of choice, CE is safe and can establish the diagnosis of Crohn's disease in patients when ileocolonoscopy results are negative or the terminal ileum cannot be evaluated. ClinicalTrials.gov Number: NCT00487396. (Less)
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keywords
Diagnostic Techniques and Procedures, Digestive System, Gastrointestinal, Tract, Radiology
in
Clinical Gastroenterology and Hepatology
volume
12
issue
4
pages
609 - 615
publisher
Elsevier
external identifiers
  • wos:000333057500017
  • scopus:84896096320
ISSN
1542-7714
DOI
10.1016/j.cgh.2013.09.028
language
English
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yes
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dd455b29-c31c-403f-b53b-8d6659dde6b5 (old id 4407511)
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2014-05-05 07:19:32
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2017-10-01 03:19:31
@article{dd455b29-c31c-403f-b53b-8d6659dde6b5,
  abstract     = {BACKGROUND &amp; AIMS: Evaluation of the small intestine for inflammation has traditionally relied on small-bowel follow-through (SBFT), but multiple studies have demonstrated its low diagnostic accuracy. Capsule endoscopy (CE) transmits high-quality images of the small intestinal mucosa; it can be used to visualize the entire length of the small bowel and much of the mucosa. We compared the diagnostic yields of CE vs SBFT in a prospective study of patients with suspected small-bowel Crohn's disease. METHODS: Eighty patients with signs and/or symptoms of small-bowel Crohn's disease (age, 10-65 years) underwent CE, followed by SBFT and ileocolonoscopy. Readers were blinded to other test results. The primary outcome was the diagnostic yield for inflammatory lesions found with CE before ileocolonoscopy compared with SBFT and ileocolonoscopy. A secondary outcome was the incremental diagnostic yield of CE compared with ileocolonoscopy and CE compared with SBFT. RESULTS: The combination of CE and ileocolonoscopy detected 107 of 110 inflammatory lesions (97.3%), whereas the combination of SBFT and ileocolonoscopy detected only 63 lesions (57.3%) (P &lt; .001). The diagnostic yield of CE compared with ileocolonoscopy was not different (P = .09). The diagnostic yield was higher for CE than for SBFT (P &lt; .001). Of the 80 patients with suspected Crohn's disease, 25 (31.3%) had the diagnosis confirmed. Eleven were diagnosed by CE findings alone and 5 by ileocolonoscopy findings alone. In the remaining 9 patients, diagnostic findings were identified by at least 2 of the 3 modalities. No diagnoses were made on the basis of SBFT findings alone. CONCLUSIONS: CE was better than SBFT and equivalent to ileocolonoscopy in detecting small-bowel inflammation. Although ileocolonoscopy remains the initial diagnostic test of choice, CE is safe and can establish the diagnosis of Crohn's disease in patients when ileocolonoscopy results are negative or the terminal ileum cannot be evaluated. ClinicalTrials.gov Number: NCT00487396.},
  author       = {Leighton, Jonathan A. and Gralnek, Ian M. and Cohen, Stanley A. and Toth, Ervin and Cave, David R. and Wolf, Douglas C. and Mullin, Gerard E. and Ketover, Scott R. and Legnani, Peter E. and Seidman, Ernest G. and Crowell, Michael D. and Bergwerk, Ari J. and Peled, Ravit and Eliakim, Rami},
  issn         = {1542-7714},
  keyword      = {Diagnostic Techniques and Procedures,Digestive System,Gastrointestinal,Tract,Radiology},
  language     = {eng},
  number       = {4},
  pages        = {609--615},
  publisher    = {Elsevier},
  series       = {Clinical Gastroenterology and Hepatology},
  title        = {Capsule Endoscopy Is Superior to Small-bowel Follow-through and Equivalent to Ileocolonoscopy in Suspected Crohn's Disease},
  url          = {http://dx.doi.org/10.1016/j.cgh.2013.09.028},
  volume       = {12},
  year         = {2014},
}