Update Kapselendoskopie – Einsatz bei chronisch-entzündlichen Darmerkrankungen

Zusammenfassung

Die Dünndarmkapselendoskopie ist im Vergleich mit radiologischen Methoden das sensitivere Verfahren im Nachweis von mukosalen Veränderungen des Dünndarms, die auf einen Morbus Crohn hinweisen. Vor allem im Jejunum und Ileum proximal des terminalen Ileums zeigt die Kapselendoskopie eine höhere Nachweisgenauigkeit als die Magnetresonanztomografie (MRT). Der hohe negativ-prädiktive Wert der Untersuchungstechnik qualifiziert sie zu einer exzellenten Methode, eine chronisch-entzündliche Darmerkrankung ggf. auszuschließen. Eine Änderung im therapeutischen Vorgehen wird durch die kapselendoskopische Untersuchung in bis zu 50 % der Fälle beschrieben, bei Kindern kann dies in bis zu 80 % der Fall sein. Auch bei den Kindern sollte natürlich einer Retention der Videokapsel durch Patientenauswahl und ggf. Anwendung der „Patency“-Kapsel vorgebeugt werden. Vorschläge zu Kapselendoskopie-Scores liegen vor, eine umfassende Validierung in prospektiven Patientenkohorten mit Bezug zum klinischen Befinden der Patienten steht noch aus. Die Kolonkapselendoskopie scheint vielversprechend im Einsatz bei chronisch-entzündlichen Darmerkrankungen, der genaue Stellenwert bleibt derzeit noch offen und muss durch zukünftige Studien evaluiert werden.

Abstract

Small bowel capsule endoscopy is more sensitive in detecting small bowel Crohn’s disease in the proximal small bowel than magnetic resonance imaging. It provides a high negative predictive value and thereby offers the capability to exclude chronic inflammatory bowel disease. Clinical management changes in up to 50 % of adult patients in the published series, and up to 80 % of pediatric patients profit from a therapeutic impact of this technique. In children as well as in adults, capsule retention needs consideration, and the patency capsule might reliably prevent video capsule retention. Colon capsule endoscopy is promising in use in chronic-inflammatory bowel disease, but prospective studies are needed to evaluate

Schlüsselwörter

Endoskopie - Kapselendoskopie - Morbus Crohn - Dünndarm - Enteroskopie

Key words

endoscopy - capsule endoscopy - Crohn’s disease - small bowel - enteroscopy

• Literatur

• 1 Albert JG. Update Kapselendoskopie – Einsatz bei Morbus Crohn. Endo heute 2010; 23: 124-126
• 2 Dionisio PM, Gurudu SR, Leighton JA et al. Capsule endoscopy has a significantly higher diagnostic yield in patients with suspected and established small-bowel Crohn’s disease: a meta-analysis. Am J Gastroenterol 2010; 105: 1240-1248 quiz 1249
• 3 Yadav A, Heigh RI, Hara AK et al. Performance of the patency capsule compared with nonenteroclysis radiologic examinations in patients with known or suspected intestinal strictures. Gastrointest Endosc 2011; 74: 834-839
• 4 Herrerias JM, Leighton JA, Costamagna G et al. Agile patency system eliminates risk of capsule retention in patients with known intestinal strictures who undergo capsule endoscopy. Gastrointest Endosc 2008; 67: 902-909
• 5 Doherty GA, Moss AC, Cheifetz AS. Capsule endoscopy in suspected Crohn’s disease: “yield” does not equal “diagnosis”. Am J Gastroenterol 2010; 105: 2111 author reply 2011-2012
• 6 Albert JG, Martiny F, Krummenerl A et al. Diagnosis of small bowel Crohn’s disease: a prospective comparison of capsule endoscopy with magnetic resonance imaging and fluoroscopic enteroclysis. Gut 2005; 54: 1721-1727
• 7 Jensen MD, Nathan T, Rafaelsen SR et al. Diagnostic accuracy of capsule endoscopy for small bowel Crohn’s disease is superior to that of MR enterography or CT enterography. Clin Gastroenterol Hepatol 2011; 9: 124-129
• 8 Bourreille A, Ignjatovic A, Aabakken L et al. Role of small-bowel endoscopy in the management of patients with inflammatory bowel disease: an international OMED-ECCO consensus. Endoscopy 2009; 41: 618-637
• 9 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
• 10 Lopes S, Figueiredo P, Portela F et al. Capsule endoscopy in inflammatory bowel disease type unclassified and indeterminate colitis serologically negative. Inflamm Bowel Dis 2010; 16: 1663-1668
• 11 Murrell Z, Vasiliauskas E, Melmed G et al. Preoperative wireless capsule endoscopy does not predict outcome after ileal pouch-anal anastomosis. Dis Colon Rectum 2010; 53: 293-300
• 12 Adler SN, Yoav M, Eitan S et al. Does capsule endoscopy have an added value in patients with perianal disease and a negative work up for Crohn’s disease?. World J Gastrointest Endosc 2012; 4: 185-188
• 13 Wiarda B, Stolk MFJ, Heine D et al. Patient Burden and Patient Preference: Comparing Magnetic Resonance Enteroclysis, Capsule Endoscopy and Balloon-Assisted Enteroscopy. J Gastroenterol Hepatol 2013; 28: 464-471
• 14 Golder SK, Schreyer AG, Endlicher E et al. Comparison of capsule endoscopy and magnetic resonance (MR) enteroclysis in suspected small bowel disease. Int J Colorectal Dis 2006; 21: 97-104
• 15 Dussault C, Gower-Rousseau C, Salleron J et al. Small bowel capsule endoscopy for management of Crohn’s disease: A retrospective tertiary care centre experience. Dig Liver Dis 2013; 45: 558-561
• 16 van Tuyl SAC, van Noorden JT, Stolk MFJ, Kuipers EJ. Clinical consequences of videocapsule endoscopy in GI bleeding and Crohn’s disease. Gastrointest Endosc 2007; 66: 1164-1170
• 17 O’Donnell S, Qasim A, Ryan BM et al. The role of capsule endoscopy in small bowel Crohn’s disease. J Crohns Colitis 2009; 3: 282-286
• 18 Gralnek IM, Cohen SA, Ephrath H et al. Small bowel capsule endoscopy impacts diagnosis and management of pediatric inflammatory bowel disease: a prospective study. Dig Dis Sci 2012; 57: 465-471
• 19 Tukey M, Pleskow D, Legnani P et al. The utility of capsule endoscopy in patients with suspected Crohn’s disease. Am J Gastroenterol 2009; 104: 2734-2739
• 20 Sidhu R, Brunt LK, Morley SR et al. Undisclosed use of nonsteroidal anti-inflammatory drugs may underlie small-bowel injury observed by capsule endoscopy. Clin Gastroenterol Hepatol 2010; 8: 992-995
• 21 Sidhu R, Sanders DS, Wilson P et al. Faecal lactoferrin, capsule endoscopy and Crohn’s disease. Is there a three way relationship? A pilot study. J Gastrointestin Liver Dis 2010; 19: 257-260
• 22 Koulaouzidis A, Douglas S, Rogers MA et al. Fecal calprotectin: a selection tool for small bowel capsule endoscopy in suspected IBD with prior negative bi-directional endoscopy. Scand J Gastroenterol 2011; 46: 561-566
• 23 Jensen MD, Kjeldsen J, Nathan T. Fecal calprotectin is equally sensitive in Crohn’s disease affecting the small bowel and colon. Scand J Gastroenterol 2011; 46: 694-700
• 24 Sipponen T, Haapamaki J, Savilahti E et al. Fecal calprotectin and S100A12 have low utility in prediction of small bowel Crohn’s disease detected by wireless capsule endoscopy. Scand J Gastroenterol 2012; 47: 778-784
• 25 Fritscher-Ravens A, Scherbakov P, Bufler P et al. The feasibility of wireless capsule endoscopy in detecting small intestinal pathology in children under the age of 8 years: a multicentre European study. Gut 2009; 58: 1467-1472
• 26 Di Nardo G, Oliva S, Ferrari F et al. Usefulness of wireless capsule endoscopy in paediatric inflammatory bowel disease. Dig Liver Dis 2011; 43: 220-224
• 27 Cohen SA, Gralnek IM, Ephrath H et al. The use of a patency capsule in pediatric Crohn’s disease: a prospective evaluation. Dig Dis Sci 2011; 56: 860-865
• 28 Nuutinen H, Kolho K, Salminen P et al. Capsule endoscopy in pediatric patients: Technique and results in our first 100 consecutive children. Scand J Gastroenterol 2011; 46: 1138-1143
• 29 Casciani E, Masselli G, Di Nardo G et al. MR enterography versus capsule endoscopy in paediatric patients with suspected Crohn’s disease. Eur Radiol 2011; 21: 823-831
• 30 Stuart S, Conner T, Ahmed A et al. The smaller bowel: imaging the small bowel in paediatric Crohn’s disease. Postgrad Med J 2011; 87: 288-297
• 31 Niv Y, Ilani S, Levi Z et al. Validation of the Capsule Endoscopy Crohn’s Disease Activity Index (CECDAI or Niv score): a multicenter prospective study. Endoscopy 2012; 44: 21-26
• 32 Rosa B, Moreira MJ, Rebelo A et al. Lewis Score: a useful clinical tool for patients with suspected Crohn’s Disease submitted to capsule endoscopy. J Crohns Colitis 2012; 6: 692-697
• 33 Gralnek IM, Defranchis R, Seidman E et al. Development of a capsule endoscopy scoring index for small bowel mucosal inflammatory change. Aliment Pharmacol Ther 2008; 27: 146-154
• 34 Sung J, Ho KY, Chiu HM et al. The use of Pillcam Colon in assessing mucosal inflammation in ulcerative colitis: a multicenter study. Endoscopy 2012; 44: 754-758
• 35 Ye CA, Gao YJ, Ge ZZ et al. PillCam COLON capsule endoscopy versus conventional colonoscopy for the detection of the severity and extent of ulcerative colitis. J Dig Dis 2012;
• 36 Acosta MSJ, Cuesta AB, Álvarez ÁC et al. Pillcam Colon (C2) vs. Colonoscopy in the Assessment of Colon Mucosa in Patients with Ulcerative Colitis. Endoscopy 2012; 44: A126
• 37 Heinzow HS, Lügering A, Domagk D et al. Assessing Disease Activity of Ulcerative Colitis with Colon Capsule Endoscopy versus Standard Colonoscopy. Gut 2012; 61: A27