Performance of Capsule Endoscopy and Cross-Sectional Techniques in Detecting Small Bowel Lesions in Patients with Crohn’s Disease

• Published in: Crohn's & colitis 360 2020-04, Vol.2 (2), p.otaa046-otaa046
• Main Authors: Calabrese, Carlo, Diegoli, Margherita, Dussias, Nikolas, Salice, Marco, Rizzello, Fernando, Cappelli, Alberta, Ricci, Claudio, Gionchetti, Paolo
• Format: Article
• Language: English
• ISSN: 2631-827X; 2631-827X
• DOI: 10.1093/crocol/otaa046

BackgroundCrohn’s disease (CD) can be classified according to endoscopic and cross-sectional imaging characteristics. Information regarding disease extent and phenotype may be provided by advanced endoscopic and imaging techniques. In this study, we compare the ability of capsule endoscopy (CE) and cross-sectional imaging techniques (CST) (MRE/Computer Tomography Enteroscopy [CTE]) in detecting small bowel (SB) lesions.MethodsWe retrospectively analyzed 102 patients with a diagnosis of CD who underwent both CE and CST. Only patients with at least a 12-month follow-up after CE were included.ResultsSensitivity and specificity for the detection of SB lesions were, respectively, 100% and 83.3% for CE, 55.1% and 80% for CTE, and 60% and 82.3% for MRE. CE detected proximal CD lesions in 73% of patients, whereas MRE and CTE detected proximal lesions in 41% and 16% of patients, respectively (P < 0.001). Positive findings on CE led to management changes in all patients, in a median follow-up period of 58.7 months. During the follow-up period, 26.5% of patients underwent surgery. Multivariate analysis revealed that moderate-to-severe disease at CE was independently correlated with surgery (P = 0.03).ConclusionsCE has a superior sensitivity for detecting CD lesions in the proximal and medium SB compared with CST. In the terminal ileum, MRE and CTE displayed similar performance to CE.Lay SummaryCrohn’s disease is a heterogeneous entity including a variety of complex phenotypes, and there is no single procedure for diagnosis. Capsule endoscopy demonstrated superior sensitivity in the proximal-medium small bowel while extra-luminal complications were detected more accurately by cross-sectional techniques.