A Meta-Analysis of the Yield of Capsule Endoscopy Compared to Other Diagnostic Modalities in Patients with Non-Stricturing Small Bowel Crohn's Disease

Abstract

In study populations, CE is superior to all other modalities for diagnosing non-stricturing small bowel CD, with a number needed to test (NNT) of 3 to yield one additional diagnosis of CD over small bowel barium radiography and NNT = 7 over colonoscopy with ileoscopy. These results are due to a highly significant IY with CE over all other modalities in patients with established non-stricturing CD being evaluated for a small bowel recurrence. While there was no significant difference seen between CE and alternate modalities for diagnosing small bowel CD in patients with a suspected initial presentation of CD, the trend toward significance for a number of modalities suggests the possibility of a type II error. Larger studies are needed to better establish the role of CE for diagnosing small bowel CD in patients with a suspected initial presentation of CD.

Role of capsule endoscopy in inflammatory bowel disease

“…Patients with suspected small bowel stenosis were excluded from VCE evaluation in these studies. The superiority of VCE over small bowel follow-through and enteroclysis has been repeatedly demonstrated in multiple studies [15][16][17][18] .…”

Capsule Endoscopy: A Comprehensive Review

“…Compared with PE, CE had a 38% higher yield, and when compared with CT enterography, the yield of CE was 69% vs 30%. Due to its high diagnostic yield, CE will have a very important place in the diagnostic workup of patients with CD, but more studies are needed to make such suggestions since there was no statistical significance in the incremental yield between CE and other diagnostic modalities in patients suspected of having CD in an meta analysis (Triester et al, 2006). However, there was a significant difference in yield of CE over alternative methods in patients with known CD, who were being evaluated for SB recurrence (Triester et al, 2006) Yield of CE is low when performed in patients with abdominal pain alone; when other criteria are added, this yield is increased (Lewis, 2008).Capsule endoscopy can be used for the assessment of mucosal healing after treatment.…”

“…In particular, depletion of the two silver oxide batteries used in current devices may prevent complete imaging of the small intestine if the pill remains in the stomach for too long. The problem becomes most apparent by the inability to view the cecum (the marker of a complete examination) in 10%-15% of CE examinations of the small bowel (Neu et al,2005;Triester et al,2006).This will eventually be overcome by using power transfer methods from outside the body. In the short term, this problem can partly be solved by using more efficient power management algorithms that enable an 11 h recording time.…”

The Effect of Metoclopramide in Capsule Enteroscopy

“…CE has established indications in obscure gastrointestinal bleeding (OGIB), suspected Crohn's disease and small bowel tumors, surveillance in patients with polyposis syndromes, and suspected or refractory malabsorptive syndromes such as celiac disease [3,4]. Its diagnostic yield is very good when compared with other diagnostic methods, and has a positive impact on clinical management [5][6][7][8][9][10][11][12][13]. However, the diagnostic yield depends on the enteroscopy completion rates to the cecum.…”