Capsule endoscopy in patients with Crohn's disease: diagnostic yield and safety

BackgroundCapsule endoscopy (CE) is increasingly used in patients with suspected or known Crohn's disease (CD).ObjectiveTo determine the diagnostic yield of CE and the distribution of small-bowel (SB) lesions in symptomatic patients with known CD.Design and SettingRetrospective review of CE procedures performed in patients with CD between 2001 and 2005 in a tertiary care center.PatientsOne hundred thirty-four patients with an established diagnosis of CD and symptoms suggestive of active disease.InterventionsSwallowing the capsule.Main Outcome MeasurementsDiagnostic yield of CE and distribution of SB lesions in patients with CD.ResultsOne hundred forty-six CE procedures were performed on 134 CD patients. Fifty-two (39%) of 134 patients had CE findings diagnostic of active CD (>3 ulcerations), and 17 (13%) had findings suggestive of active CD (≤3 ulcerations). Fifty-seven (42%) patients had normal findings, and 6% had normal but incomplete studies. The distribution of SB lesions was 32% in the duodenum, 53% in the jejunum, 67% in the proximal ileum, and 85% in the distal ileum. CE was comparable to ileoscopy in detecting ileal ulcerations (55% vs 48%), but superior to SB follow-through in detecting CD lesions in the SB (incremental yield of 32%; 95% CI, 9%-54%; P = .0017).LimitationsRetrospective study from a single center.ConclusionsCE identified SB lesions in approximately half of symptomatic CD patients. Large-scale prospective studies are needed to evaluate whether positive CE findings may affect disease outcomes.