Comparison of Capsule Endoscopy with Ileocolonoscopy for Detecting Small-Bowel Lesions in Patients with Seronegative Spondyloarthropathies

Eliakim, R; Karban, Amir; Markovits, Doron; Bardan, Eytan; Bar‐Meir, Simon; Abramowich, Dov; Scapa, Eitan

doi:10.1055/s-2005-870559

Cited by 18 publications

(10 citation statements)

References 7 publications

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“…The most noteworthy difference between earlier reports and our study is the use of CE, a superior modality for diagnosing small bowel pathologies compared to colonoscopy and cross-sectional imaging 17,18,19,20,30 . CE enables the detection of lesions outside the reach of endoscopic techniques.…”

Section: Discussioncontrasting

confidence: 86%

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Detection of Crohn Disease in Patients with Spondyloarthropathy: The SpACE Capsule Study

Kopylov

Starr²,

Watts³

et al. 2018

J Rheumatol

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Objective.Inflammatory bowel disease (IBD) is generally reported to be associated with spondylarthropathies (SpA) in 5%–15% of cases. Systematic colonoscopic assessment by protocol demonstrated mucosal inflammation characteristic of Crohn disease (CD) in up to one-third of patients with SpA. Video capsule endoscopy (CE) is a superior diagnostic tool to detect small bowel mucosal disease. Our study compared the accuracy of CE to standard colonoscopy for detection of inflammatory bowel lesions in patients with SpA, and to describe predictors of small bowel inflammation (SBI) in this cohort.Methods.Prospective cross-sectional study of adult patients followed for SpA. Patients were evaluated by CE and standard colonoscopy with biopsies. SBI was quantified using the Lewis Score. Additional screening tests included fecal calprotectin (FCP), C-reactive protein (CRP), and a diagnostic panel of serologic, inflammatory and genetic tests (SGI).Results.There were 64 patients recruited (53% female, mean age 42 ± 13 yrs). Chronic gastrointestinal (GI) symptoms were present in 57%. CE revealed significant SBI in 27/64 (42.2%), compared to 7/64 (10.9%) by standard colonoscopy (p = 0.035). Elevated FCP was associated with small bowel CD (OR 4.5, 95% CI 1.01–19.9; p = 0.042). No correlation was observed with presence of GI symptoms, CRP, or SGI results. Finding CD led to a change in management in 65.2% of cases.Conclusion.CE uncovered SBI consistent with CD in 42.2% of patients with SpA, with a significant incremental yield over colonoscopy of 31%. FCP levels were significantly correlated with CE results, while GI symptoms and SGI results were poor predictors of SBI.

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Section: Discussioncontrasting

confidence: 86%

“…The primary objective of our study was to determine whether CE can more reliably reveal SBI due to CD in subjects with SpA versus colonoscopy. One pilot study was published supporting this concept 20 . SBI was demonstrated by CE in 6/20 patients, compared to only 1/20 by colonoscopy.…”

Section: Rheumatologymentioning

confidence: 99%

Detection of Crohn Disease in Patients with Spondyloarthropathy: The SpACE Capsule Study

Kopylov

Starr²,

Watts³

et al. 2018

J Rheumatol

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“…The reason has been the absence of a superior endoscopic method for the small bowel, mainly because of the difficulty of inserting an endoscope into the deeper small bowel [7], and therefore improvement in endoscopic technology has been expected.…”

Section: Discussionmentioning

confidence: 99%

Small bowel tuberculosis diagnosed by the combination of video capsule endoscopy and double balloon enteroscopy

Nakamura

Niwa

Ohmiya

et al. 2007

European Journal of Gastroenterology & Hepatology

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Small bowel tuberculosis is sometimes encountered in oriental countries, and because its symptoms are vague and present a nonspecific pattern, confirmative diagnosis is difficult to achieve. In 2001, two new innovative endoscopic techniques for the small bowel, video capsule endoscopy and double balloon enteroscopy, were introduced, thus advancing the diagnostic technology for small bowel disorders. Our asymptomatic patient with small bowel tuberculosis was diagnosed definitively using the combination of video capsule endoscopy and double balloon enteroscopy. The number of such cases will increase when those procedures become more widely used. At present, the endoscopic view of small bowel tuberculosis is difficult to differentiate from Crohn's disease and drug-induced enteropathy, but from now on it will be possible to distinguish them utilizing endoscopic and fluoroscopic images. On the basis of the characteristics of small bowel tuberculosis with its endoscopic images, referring to our case report and previous literature, we report a topical diagnostic procedure, the combination of video capsule endoscopy and double balloon enteroscopy.

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“…Fecal calprotectin levels are elevated in children with SpA [17], but they do not provide specific anatomical information within the intestines, and it appears that their levels can be increased nearly two-fold by use of non-steroidal anti-inflammatory drugs [19,20]. Likewise, wireless capsule endoscopy (WCE) can identify subclinical changes in SpA patients [21]; however, WCE does not identify changes beyond the intestinal mucosa, and is limited by risk of obstruction.…”

Section: Resultsmentioning

confidence: 99%

MR enterography to evaluate sub-clinical intestinal inflammation in children with spondyloarthritis

et al. 2012

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BackgroundMagnetic resonance enterography (MRE) is an established tool to evaluate for changes associated with inflammatory bowel disease (IBD), but has not been studied in sub-clinical IBD. We sought to evaluate the use of MRE in children with spondyloarthritis (SpA), who are at risk of having sub-clinical gut inflammation.MethodsChildren with juvenile idiopathic arthritis (JIA) with evidence of intestinal inflammation as evidence by an abnormal fecal calprotectin assay were offered MRE of their intestines. Flavored sports drink containing polyethylene glycol 3350 was used as oral contrast. Glucagon was used to arrest peristalsis. Patients were imaged in the prone position on a 1.5 T scanner. Heavily T2-weighted fat-suppressed coronal and axial images using breath-hold technique were obtained, followed by post-gadolinium fat-suppressed T1-weighted gradient echo images.ResultsWe recruited five children with juvenile idiopathic arthritis (JIA); four had SpA, and one had poly-articular JIA. All five had evidence of intestinal inflammation based upon a positive fecal calprotectin assay and successfully completed the MRE. Three of the studies showed findings suggestive of IBD, including thickening and contrast uptake at the terminal ileum (TI) in one child, contrast uptake of the distal ileum in another, and prominent vasa recta and mesenteric lymph nodes in the third. The child with evidence of inflammatory changes at the TI underwent colonoscopy, which revealed inflammatory bowel disease limited to the TI.ConclusionsMRE can be used to evaluate for subclinical IBD in children with JIA. This protocol was safe and well-tolerated, and identified mild changes in three of the subjects.

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Comparison of Capsule Endoscopy with Ileocolonoscopy for Detecting Small-Bowel Lesions in Patients with Seronegative Spondyloarthropathies

Abstract: Capsule endoscopy detected more small-bowel lesions than ileocolonoscopy, and provided additional potentially relevant information on upper gastrointestinal pathology in patients with spondyloarthropathies.

Cited by 18 publications

References 7 publications

Detection of Crohn Disease in Patients with Spondyloarthropathy: The SpACE Capsule Study

Detection of Crohn Disease in Patients with Spondyloarthropathy: The SpACE Capsule Study

Small bowel tuberculosis diagnosed by the combination of video capsule endoscopy and double balloon enteroscopy

MR enterography to evaluate sub-clinical intestinal inflammation in children with spondyloarthritis

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