Impact of Capsule Endoscopy on the Assessment and Management of Inflammatory Bowel Disease

Aims To define the indications, assessment and management changes prompted by IBD evaluation through VCE.

Methods Descriptive, retrospective study of all IBD patients evaluated through the SB3 type Medtronic VCE model in our center between January 2019 and December 2023. Endoscopic, clinical and management variables were included.

Results We assessed 33 VCE in a total of 31 patients. Mean age was 44.29 years, and a slight male predominance was observed (54.83%). 35% of these patients had had a colonoscopy in the previous 6 months. 7 of these showed active disease, 3 had been diagnosed of indeterminate IBD, 3 of them of ulcerative colitis (UC) and 1 of Crohn´s Disease (CD). 16% of all patients had had a magnetic resonance enterography (MRE) in the same period, 2 of which had shown disease activity. 10% of patients had had both tests (of which 1 patient had active disease in both of them), and 39% had had none of these. Graph 1 summarizes indications for according to diagnostic tests and disease activity. Table 1 summarizes treatment, disease behavior and location prior to the VCE.

Before VCE, 14 patients were on maintenance mesalazine and 5 had no maintenance treament (both groups comprising 57% of all patients). Of these, 79% had a diagnosis of CD (6 L3, 4 L4 and 5 L1), 10.5% of indeterminate IBD, and 10.5% of ulcerative proctitis. 47% of patients had not had a colonoscopy or an MRE in the previous 6 months. 32% had had a colonoscopy, of which 3 had shown disease activity (2 cases of indeterminate IBD and 1 case of active proctitis), and 21% had had an MRE, of which 2 had shown disease activity (L1 and L3, respectively). Through the VCE assessment, 85% of patients keep the same Montreal classification, while 9% switch from B1 to B2, 3% from indeterminate IBD to UC, and 3% from L1 to L3. Graph 3 shows all cases rated by disease activity, specifying ulterior management. In patients with a Lewis score (LS) of<135, treatment was initiated in those presenting with colonic disease activity corroborated by another diagnostic test. Within the segment of patients with a LS of 135-790, no treatment was initiated in any patients<500.

Conclusions In approximately a third of cases, a VCE was indicated without any recent colonoscopy or MRE. While it is true that VCE is the most sensitive test for detecting disease activity in the small bowel, it is not devoid of risks. This, as well as the costs involved, should elicit consideration on which should the best first-line test for each activity degree. Of note, the most frequent maintenance therapy prior to VCE was mesalazine, and several patients had been prescribe no maintenance treatment. Of these, almost half had not had a colonoscopy or MRE before the VCE; and in those that did and in which disease activity had been detected, VCE was nevertheless still ordered.

Publication History

Article published online:
27 March 2025