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Capsule Endoscopy and CT Enteroclysis in Crohn Disease

Wireless capsule endoscopy is a sensitive tool for detecting small-bowel CD.

Computed tomography (CT) enteroclysis is emerging as the gold standard radiographic test for diagnosing small-bowel disease. This is the first prospective study in which CT enteroclysis was compared with wireless capsule endoscopy. Fifty-six consecutive Crohn disease (CD) patients underwent upper endoscopy, ileal colonoscopy, CT enteroclysis, and wireless capsule endoscopy within 2 weeks; 15 patients had stenoses less than 1 cm on CT enteroclysis and were excluded from undergoing wireless capsule endoscopy.

Of the 41 patients who underwent both wireless capsule endoscopy and CT enteroclysis, 33 had active disease (CD activity index >150), and 8 had quiescent disease. Although the neoterminal ileum was examined by capsule endoscopy in only 32 patients, the capsule detected small intestinal CD lesions in significantly more patients (23 vs. 10) and detected large lesions in numerically more patients (8 vs. 5) than did CT enteroclysis. Wireless capsule endoscopy led to treatment changes in 10 patients; it established suspected CD diagnoses in 5 patients (in whom all other diagnostic procedures were negative), it detected symptomatic strictures in the small bowel that were undetected by CT enteroclysis in 2 patients, and it identified previously undetected inflammation in small-bowel segments in 3 patients with active CD.

Comment: These prospective results suggest that CT enteroclysis and wireless capsule endoscopy are complementary for diagnosis and management of Crohn disease. Wireless capsule endoscopy is more sensitive for detection of active mucosal disease and can identify strictures in patients who do not have strictures identified on CT enteroclysis. Wireless capsule endoscopy also might redefine the extent of CD. Wireless capsule endoscopy appears to be the most sensitive test available for detection of small-bowel CD, except perhaps in patients with isolated neoterminal ileal disease, in whom colonoscopy remains the best detection method.

— Douglas K. Rex, MD

Published in Journal Watch Gastroenterology March 29, 2005

Citation(s):

Voderholzer WA et al. Small bowel involvement in Crohn's disease: A prospective comparison of wireless capsule endoscopy and computed tomography enteroclysis. Gut 2005 Mar; 54:369-73.

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