SMALL BOWEL CAPSULE ENDOSCOPY IS A VALUABLE DIAGNOSTIC TOOL IN ISOLATED TERMINAL ILEITIS

Aims Terminal ileitis (TI), is a common condition in clinical practice and may be associated with a wide variety of diseases. Small bowel capsule endoscopy (SBCE) is a valuable diagnostic tool for small bowel diseases, however data regarding its diagnostic impact on isolated TI is sparse.

Aim To evaluate the diagnostic value of SBCE for TI detected during ileocolonoscopy.

Methods Retrospective study including consecutive patients undergoing SBCE after diagnosis of TI without colonic mucosal abnormalities on ileocolonoscopy between January 2016 and September 2019. Demographic, clinical, biochemical, endoscopic and imaging data were collected.

Results One hundred and two patients with isolated TI on ileocolonoscopy were included. Positive findings on SBCE were found in 84(82.4%) patients, being ulcers the most common finding (76.5%). Endoscopic abnormalities proximal to terminal ileum were found in 36.3% of patients. After SBCE, 63.7% of patients had a final diagnosis, Crohn’s disease (CD) was the most common (34.3%), followed by NSAIDs enteropathy (12.7%). Elevated fecal calprotectin (p=0.001) was independently associated with positive SBCE findings. There was a tendency for high levels of erythrocyte sedimentation rate be associated with positive findings (p=0.07). However, the presence of symptoms, imaging abnormalities and other laboratory findings such as leukocytosis, anemia, and elevated C-reactive protein were not predictors of positive SBCE findings. At multivariate analysis, only elevated fecal calprotectin (OR6.0, IC 95%1.9-18.7;p=0.002) was a significant predictive factor for positive SBCE findings.

Conclusions SBCE revealed a high diagnostic yield in patients with isolated ileitis on ileocolonoscopy enabling a definite diagnosis in almost two thirds of patients. Approximately one-third of patients had findings proximal to terminal ileum and a similar percentage was diagnosed with CD. In patients with isolated ileitis on ileocolonoscopy, SBCE should be considered to evaluate small bowel lesions, particularly when there is an elevated fecal calprotectin, even when other clinical, imagiological or laboratorial abnormalities are absent.