Aims Small Bowel Capsule Endoscopy (SBCE) is a valuable tool in visualizing the small
intestines. Paired with Double Balloon Enteroscopy (DBE), we can now obtain histological
evidence to investigate small bowel Crohn’s disease. We assessed diagnostic yield
using both these investigative modalities.
Methods We performed a retrospective analysis from March 2021 to September 2024 of patients
referred to our small bowel capsule service. A patient list was generated from our
local capsule database for suspected Crohn’s disease. PillCam SB3 was the only capsule
included in this study for consistency purposes. There was also only one reporting
gastroenterologist. Previous colonoscopy, histology, faecal calprotectin and MR enterography
(MRE) were also analysed. I have performed linear regression statistical analysis
of these variables.
Results 94 patients included over a 3-year period, 50% were female (p=0.81 therefore no significant
correlation of female sex to capsule findings in keeping with Crohn’s disease) with
a median of 44 years ranging from 16-80. All referrals were for patients who did not
have a diagnosis of Crohn’s prior to their capsule endoscopy. 99% patients had a complete
study with only one patient retaining the capsule in the stomach. 46 had Colonoscopy,
26 had raised faecal calprotectin (median 160 ranging from 5->6000) and 8 had an abnormal
MRE before referral. These 8 abnormal MRE findings included, 5 reported as mural thickening
of small bowel, one of a proximal jejunal stricture, one of inflammation at the terminal
ileum and the last reported as active small bowel disease and distal terminal ileitis.
A raised faecal calprotectin was not statistically significant for a capsule finding
in keeping with Crohn’s disease with p=0.357 however, an abnormal MRE report was p=0.034.
64.8% of SBCE performed had an abnormal report, 35.1% had a capsule findings in keeping
with a Crohn’s diagnosis i.e 54% of abnormal findings on capsule were indicative of
Crohn’s disease. Further investigations included repeat SBCE (10.7%), repeat ileocolonoscopy
(1.96%) or DBE (RDBE 16.6% and ADBE 10.7%). Patients underwent repeat capsule studies
mostly due to assess healing of ulcers/erosions alongside, nonspecific enteritis to
clarify significance and one case of a retained capsule in stomach and one case of
recurrent abdominal pain after a DBE [1]
[2]
[3].
Conclusions Small Bowel Capsule and Double Balloon Enteroscopy are very important modalities
in diagnosing and treating small bowel pathologies. From this audit it was found to
have good diagnostic yield for the diagnosis of small bowel Crohn’s with over half
of abnormal capsule reports leading to a Crohn’s diagnosis. MRE has shown a significant
precursor to Capsule endoscopy and I would imagine intestinal ultrasound in the near
future will play a similar role. To further this work, I will assess the specific
location of small bowel disease and correlate this to faecal calprotectin levels.
