Clinical utility of capsule endoscopy in patients with Crohn’s disease and inflammatory bowel disease unclassified

Kalla, Rahul; McAlindon, Mark E.; Drew, K; Sidhu, Reena

doi:10.1097/meg.0b013e32835ddb85

Cited by 36 publications

(30 citation statements)

References 34 publications

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“…The Japanese diagnostic criteria for CD were established on the basis of morphological findings [29], and include longitudinal ulcer and cobblestone-like appearance as major findings, and irregular-shaped and/or quasi-circular ulcers or aphthous ulcerations found extensively in the gastrointestinal tract as one of the minor findings. Confirmation of these findings by CE has been reported as useful for differentiating CD from IBDU and IC [30-32]. Other reported CE findings in CD include notching of folds, erythema, edema, loss of villi, abnormal vascularity, small aphthous ulcers, linear ulcers, strictures, and mucosal fissure [33, 34].…”

Section: Discussionmentioning

confidence: 94%

Comparison of Small Bowel Lesions Using Capsule Endoscopy in Ulcerative Colitis and Crohn’s Disease: A Single-Center Retrospective Analysis

et al. 2018

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Background: Capsule endoscopy (CE) has allowed the characterization of small bowel lesions. However, small bowel lesions in ulcerative colitis (UC) have not been elucidated and no studies have compared between UC and Crohn’s disease (CD). Aim: The objective of this study was to investigate the small bowel lesions in UC, and to characterize UC lesions by comparison with CD. Methods: Subjects comprised 54 UC patients and 39 CD patients who underwent CE. We retrospectively investigated characteristics of small bowel lesions in UC. We also compared endoscopic findings and degree of inflammation between UC and CD. Results: The incidence of small bowel lesions in UC was 27.8%. The group with small bowel lesions exhibited higher endoscopic activity in the colon than without small bowel lesions (p = 0.002). Comparing small bowel lesions between UC and CD, significantly more ulcerative lesions, notched appearance, longitudinal tendency of lesions, and cobblestone appearance were seen in CD. The Lewis score was significantly higher in CD than UC in the second and third tertiles (205 ± 379 vs. 73 ± 223, p = 0.01; 358 ± 449 vs. 105 ± 333, p < 0.001). Conclusions: Small bowel lesions in UC were linked to colonic activity. UC and CD differ in terms of the morphology and distribution of small bowel lesions.

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Section: Discussionmentioning

confidence: 94%

Comparison of Small Bowel Lesions Using Capsule Endoscopy in Ulcerative Colitis and Crohn’s Disease: A Single-Center Retrospective Analysis

et al. 2018

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“…SBCE may also be a key diagnostic instrument if it reveals small bowel lesions consistent with CD in adequately selected patients [10][11][12][13]. In patients with established CD, capsule endoscopy is useful to evaluate disease extent and activity [3,4], as it may influence therapeutic decisions by detecting previously unknown small bowel lesions [14][15][16]. SBCE has been used to investigate CD patients with atypical symptoms, unexplained anemia or obscure GI bleeding1, as well as in the post-operative setting [17,18].…”

Section: Capsule Endoscopy In Patients With Crohn's Diseasementioning

confidence: 99%

Pillcam Colon 2 in Crohn's Disease: Pan-enteric Tool for a Pan-enteric Disease

Rosa¹,

Carvalho²,

Cotter³

2015

Int J Gastroenterol Disord Ther

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requires colon preparation, colon capsule endoscopy does not require insufflation or sedation, and the risks associated with the procedure are minimal [25,27]. Currently on its second-generation, this colon capsule (PillCam® COLON 2, PCC-2) measures 11.6 mm × 31.5 mm and it has one camera at each end, with an angle of view of 172°, allowing for nearly 360° coverage of the colon. PCC-2 captures 4 images per second during the first 3 minutes following activation, and then works at a low rate of 14 images per minute until small bowel images are detected [22]. The capsule then turns into an adaptive frame rate mode, capturing from 4 frames per second when stationary, up to 35 frames per second when in motion [22]. With this technology, the risk of missing lesions while the capsule is moving is reduced, which may be particularly relevant during its rapid passage through the transverse colon, at the same time saving battery energy and optimizing the video length. It is also possible to get the adaptive frame rate mode activated from the beginning of the examination, even before capsule ingestion, in order to improve imaging of the upper GI tract. The data recorder (DR3) assists the medical staff and the patient through the procedure according to a pre-selected preparation protocol, by alerting and displaying on the screen a sequence of instructions, paving the way for PCC-2 to be offered as an out-of-clinic procedure [28]. Figure 1 summarizes the current protocol in our unit. With the DR3 we can use real-time viewing to selectively administer a prokinetic drug to patients with delayed gastric emptying [29]. If the capsule is still remaining in the gastric cavity one hour after ingestion, DR3 will instruct the patient to get a prokinetic such as oral domperidone. DR3 is also able to automatically detect when the capsule starts capturing images of the small bowel, with an estimated sensitivity of 98.3% sensitivity [28], subsequently activating the adaptive frame rate which will capture up to 35 frames per second, and it also alerts the patient to ingest the first booster laxative (sodium phosphate, NaP), which will accelerate small bowel transit time of the capsule and help to maintain the colon cleanliness. DR3 will also notify the patient to have a second booster of NaP, and finally a bisacodyl suppository if the capsule has not been excreted Pan-endoscopy in Crohn's DiseaseThe availability of PCC-2 triggered a new concept, based on the possibility to perform a complete examination of the whole GI tract from mouth to anus (pan-endoscopy) with a single non-invasive procedure [37]. Although the exploration of the esophagus and stomach rests sub-optimal with the currently available capsule models, the feasibility of remotely controlled prototypes has been demonstrated, making it expectable to have such limitations overcome in a near future [38][39][40][41][42][43]. Although there are currently no specific recommendations to routinely perform upper GI endoscopy in adult CD patients, it may contribute to establish the dia...

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“…Certainly, when one considers C-reactive protein, it is elevated in a variety of other inflammatory conditions and has a low specificity for inflammatory bowel diseases. In particular, it appears to be a poor surrogate for small bowel CD [37,38]. In terms of faecal markers, calprotectin, a marker of the volume of polymorphonuclear cells present in the intestine, is perhaps the most widely studied.…”

Section: Diagnosis Of Small Bowel CDmentioning

confidence: 99%

Small Bowel Crohn's Disease: An Emerging Disease Phenotype?

Hall¹,

Holleran²,

McNamara³

2014

Dig Dis

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An increasing understanding of the pathogenesis of Crohn's disease (CD), coupled with improvements in therapeutic options, has promoted the concept of stratifying patients with CD into distinct disease phenotypes according to risk. Small bowel CD, due to the numerous non-specific potential symptoms and the anatomical location of the disease, is a particularly difficult phenotype to identify. The fact that the majority of de novo strictures occur in the ileum/ileo-colonic region ensures that recognition of small bowel involvement is essential. Certainly, it is becoming increasingly recognised due to improvements in imaging and endoscopic techniques. Both CT and MR enterography appear capable of accurately diagnosing small bowel CD. Furthermore, the development of capsule endoscopy and balloon-assisted enteroscopy allow direct visualisation of the small bowel. Limited data to date would suggest that small bowel CD is a difficult entity to treat even in the current era of the ever-expanding field of biological therapies. Further long-term follow-up studies are necessary using both small bowel capsule endoscopy and cross-sectional imaging to truly assess, firstly, whether small bowel CD is more resistant to treatment and, secondly, whether it has an effect over time in terms of complications. In the future, serological and genetic tests, coupled with the aforementioned investigations, will permit early diagnosis and early treatment of small bowel CD.

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Clinical utility of capsule endoscopy in patients with Crohn’s disease and inflammatory bowel disease unclassified

Cited by 36 publications

References 34 publications

Comparison of Small Bowel Lesions Using Capsule Endoscopy in Ulcerative Colitis and Crohn’s Disease: A Single-Center Retrospective Analysis

Comparison of Small Bowel Lesions Using Capsule Endoscopy in Ulcerative Colitis and Crohn’s Disease: A Single-Center Retrospective Analysis

Pillcam Colon 2 in Crohn's Disease: Pan-enteric Tool for a Pan-enteric Disease

Small Bowel Crohn's Disease: An Emerging Disease Phenotype?

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