Endoscopy 2008; 40(1): 30-35
DOI: 10.1055/s-2007-995359
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Diagnostic yield of capsule endoscopy in ulcerative colitis and inflammatory bowel disease of unclassified type (IBDU)

S.  Mehdizadeh1 , 2 , G.  Chen3 , P.  J.  Enayati3 , D.  W.  Cheng3 , N.  J.  Han3 , O.  A.  Shaye3 , A.  Ippoliti1 , 4 , E.  A.  Vasiliauskas1 , 4 , S.  K.  Lo1 , 2 , K.  A.  Papadakis1 , 4
  • 1Division of Gastroenterology, Cedars-Sinai Medical Center and the UCLA School of Medicine, Los Angeles, California, USA
  • 2Pancreaticobiliary and Interventional Endoscopy Program, Cedars-Sinai Medical Center and the UCLA School of Medicine, Los Angeles, California, USA
  • 3Department of Medicine, Cedars-Sinai Medical Center and the UCLA School of Medicine, Los Angeles, California, USA
  • 4Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center and the UCLA School of Medicine, Los Angeles, California, USA
Further Information

Publication History

submitted 3 July 2007

accepted after revision 9 August 2007

Publication Date:
05 December 2007 (online)

Background and study aims: Capsule endoscopy is increasingly reported as an important diagnostic procedure in patients with known or suspected Crohn’s disease, but its clinical utility in patients with ulcerative colitis or unclassified type inflammatory bowel disease (IBDU) is unclear. The aim of our study was to determine the diagnostic yield of capsule endoscopy for small-bowel disease in patients with ulcerative colitis and IBDU.

Patients and methods: All data from patients with a history of ulcerative colitis or IBDU who underwent capsule endoscopy between October 2001 and August 2005 were analyzed for procedure indications and findings. Images were reviewed by an experienced capsule endoscopist. The finding of multiple ulcerations (three or more) on capsule endoscopy was classified as diagnostic of small-bowel Crohn’s disease.

Results: 120 patients had undergone 122 capsule endoscopy procedures. Overall, 19 of 120 patients (15.8 %) had capsule endoscopy findings consistent with the diagnosis of Crohn’s disease. The proportion of patients with small-bowel disease was significantly higher among patients with a history of colectomy (7 of 21 patients, 33 %) compared with those without colectomy (12/99, 12 %) (P = 0.04). Among patients with positive findings on capsule endoscopy, 18 had also previously undergone a small-bowel follow-through study and only one showed findings consistent with Crohn’s disease.

Conclusions: Many patients with a diagnosis of ulcerative colitis and atypical features or IBDU may have small-bowel findings on capsule endoscopy that are consistent with Crohn’s disease. Capsule endoscopy should be considered in ulcerative colitis patients with atypical clinical features particularly after colectomy.

References

  • 1 Mow W S, Lo S K, Targan S R. et al . Initial experience with wireless capsule enteroscopy in the diagnosis and management of inflammatory bowel disease.  Clin Gastroenterol Hepatol. 2004;  2 31-40
  • 2 Papadakis K A, Tabibzadeh S. Diagnosis and misdiagnosis of inflammatory bowel disease.  Gastrointest Endosc Clin N Am. 2002;  12 433-449
  • 3 Papadakis K A, Treyzon L, Abreu M T. et al . Infliximab in the treatment of medically refractory indeterminate colitis.  Aliment Pharmacol Ther. 2003;  18 741-747
  • 4 Silverberg M S, Satsangi J, Ahmad T. et al . Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology.  Can J Gastroenterol. 2005;  19 Suppl A 5-36
  • 5 Ruemmele F M, Targan S R, Levy G. et al . Diagnostic accuracy of serological assays in pediatric inflammatory bowel disease.  Gastroenterology. 1998;  115 822-829
  • 6 Vasiliauskas E A, Plevy S E, Landers C J. et al . Perinuclear antineutrophil cytoplasmic antibodies in patients with Crohn’s disease define a clinical subgroup.  Gastroenterology. 1996;  110 1810-1819
  • 7 Landers C J, Cohavy O, Misra R. et al . Selected loss of tolerance evidenced by Crohn’s disease-associated immune responses to auto- and microbial antigens.  Gastroenterology. 2002;  123 689-699
  • 8 Targan S R, Landers C J, Yang H. et al . Antibodies to CBir1 flagellin define a unique response that is associated independently with complicated Crohn’s disease.  Gastroenterology. 2005;  128 2020-2028
  • 9 Appleyard M, Glukhovsky A, Swain P. Wireless-capsule diagnostic endoscopy for recurrent small-bowel bleeding.  N Engl J Med. 2001;  344 232-233
  • 10 Costamagna G, Shah S K, Riccioni M E. et al . A prospective trial comparing small bowel radiographs and video capsule endoscopy for suspected small bowel disease [see comment].  Gastroenterology. 2002;  123 999-1005
  • 11 Iddan G, Meron G, Glukhovsky A, Swain P. Wireless capsule endoscopy.  Nature. 2000;  405 417
  • 12 Fireman Z, Mahajna E, Broide E. et al . Diagnosing small bowel Crohn’s disease with wireless capsule endoscopy. [See comment].  Gut. 2003;  52 390-392
  • 13 Ge Z Z, Hu Y B, Xiao S D. Capsule endoscopy in diagnosis of small bowel Crohn’s disease.  World J Gastroenterol. 2004;  10 1349-1352
  • 14 Herrerias J M, Caunedo A, Rodriguez-Tellez M. et al . Capsule endoscopy in patients with suspected Crohn’s disease and negative endoscopy.  Endoscopy. 2003;  35 564-568
  • 15 Arguelles-Arias F, Caunedo A, Romero J. et al . The value of capsule endoscopy in pediatric patients with a suspicion of Crohn’s disease.  Endoscopy. 2004;  36 869-873
  • 16 Chong A K, Taylor A, Miller A. et al . Capsule endoscopy vs. push enteroscopy and enteroclysis in suspected small-bowel Crohn’s disease.  Gastrointest Endosc. 2005;  61 255-261
  • 17 Ell C, Remke S, May A. et al . The first prospective controlled trial comparing wireless capsule endoscopy with push enteroscopy in chronic gastrointestinal bleeding.  Endoscopy. 2002;  34 685-689
  • 18 Kalantzis N, Papanikolaou I S, Giannakoulopoulou E. et al . Capsule endoscopy; the cumulative experience from its use in 193 patients with suspected small bowel disease.  Hepatogastroenterology. 2005;  52 414-419
  • 19 Lewis B S, Swain P. Capsule endoscopy in the evaluation of patients with suspected small intestinal bleeding: Results of a pilot study. [See comment].  Gastrointest Endosc. 2002;  56 349-353
  • 20 Voderholzer W A, Ortner M, Rogalla P. et al . Diagnostic yield of wireless capsule enteroscopy in comparison with computed tomography enteroclysis.  Endoscopy. 2003;  35 1009-1014
  • 21 Triester S L, Leighton J A, Leontiadis G I. et al . A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with non-stricturing small bowel Crohn’s disease.  Am J Gastroenterol. 2006;  101 954-964
  • 22 Lo S K. Capsule endoscopy in the diagnosis and management of inflammatory bowel disease.  Gastrointest Endosc Clin N Am. 2004;  14 179-193
  • 23 Buchman A L, Miller F H, Wallin A. et al . Videocapsule endoscopy versus barium contrast studies for the diagnosis of Crohn’s disease recurrence involving the small intestine.  Am J Gastroenterol. 2004;  99 2171-2177
  • 24 Melmed G Y, Lo S K. Capsule endoscopy: practical applications.  Clin Gastroenterol Hepatol. 2005;  3 411-422
  • 25 Lennard-Jones J E. Classification of inflammatory bowel disease.  Scand J Gastroenterol Suppl. 1989;  170 2-6
  • 26 Eliakim R, Suissa A, Yassin K. et al . Wireless capsule video endoscopy compared to barium follow-through and computerised tomography in patients with suspected Crohn’s disease - final report.  Dig Liver Dis. 2004;  36 519-522
  • 27 Marmo R, Rotondano G, Piscopo R. et al . Capsule endoscopy versus enteroclysis in the detection of small-bowel involvement in Crohn’s disease: a prospective trial.  Clin Gastroenterol Hepatol. 2005;  3 772-776
  • 28 Mylonaki M, Fritscher-Ravens A, Swain P. Wireless capsule endoscopy: a comparison with push enteroscopy in patients with gastroscopy and colonoscopy negative gastrointestinal bleeding.  Gut. 2003;  52 1122-1126
  • 29 Papadakis K A, Lo S K, Fireman Z, Hollerbach S. Wireless capsule endoscopy in the evaluation of patients with suspected or known Crohn’s disease.  Endoscopy. 2005;  37 1018-1022
  • 30 Swain P. Wireless capsule endoscopy and Crohn’s disease.  Gut. 2005;  54 323-326
  • 31 Maunoury V, Savoye G, Bourreille A. et al . Value of wireless capsule endoscopy in patients with indeterminate colitis (inflammatory bowel disease type unclassified).  Inflamm Bowel Dis. 2007;  13 152-155
  • 32 Voderholzer W A, Beinhoelzl J, Rogalla P. et al . Small bowel involvement in Crohn’s disease: a prospective comparison of wireless capsule endoscopy and computed tomography enteroclysis.  Gut. 2005;  54 369-373

K. A. Papadakis, MD, PhD

University of Crete
Faculty of Medicine, Department of Gastroenterology

University Hospital of Heraklion

PO Box 1352, Heraklion 71110,

Crete, Greece

Fax: +30-2810-542085

Email: Papadakis.konstantinos@gmail.com

    >