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Capsule endoscopy may miss post-op recurrence of Crohn's disease
Last Updated: 2006-07-07 19:25:09 -0400 (Reuters Health)
NEW YORK (Reuters Health) - During 6-month evaluation of patients treated surgically for Crohn's disease, a French research team has found that wireless capsule endoscopy (WCE) detects lesions that are beyond the scope of ileocolonoscopy. However, some of the lesions in the neoterminal ileum, which may bear more clinical significance than other intestinal lesions, are missed by WCE but identified by ileocolonoscopy.
"At the present time, it seems that WCE cannot systematically replace ileocolonoscopy in the regular management of patients after surgery," Dr. J. F. Colombel and associates say in their report, published in the July issue of Gut.
Severe lesions in the neoterminal ileum are currently the best predictor of early relapse following surgery, helping to determine best treatment of patients with Crohn's, according to Dr. Colombel, from the University Hospital in Lille, and other members of the team.
Ileocolonoscopy is considered the "gold standard technique" for investigation of the neointimal ileum. But compared with ileocolonoscopy, WCE is a less invasive procedure that does not require sedation, can visualize the full length of the small bowel, is capable of identifying small lesions, and is well tolerated by patients, the investigators note.
However, they add, prospective studies comparing the two methodologies for follow-up of postsurgical Crohn's disease have not been conducted. Their goal was to fill that gap.
Their study included 31 patients who had undergone an ileocolonic resection. About 6 months later, the subjects underwent capsule endoscopy using the Given M2A capsule (Given Imaging, Maison-Laffitte, France), with recording of capsule video film, followed 1 week later by ileocolonoscopy.
Two investigators interpreted WCE video films, which required a mean duration of 54 minutes, compared with 25 minutes for interpreting ileocolonoscopy.
Altogether, 21 (68%) of the patients had a recurrence in the distal ileum. Ileocolonoscopy identified 19 patients with lesions, while two were detected only with WCE. For WCE-detected lesions observed by both observers, the sensitivity was 76%, compared with 90% for ileocolonoscopy, and specificities were 91% and 100%, respectively.
The two observers detected lesions by WCE in the small intestine that were outside the scope of conventional ileocolonoscopy in 66% and 72% of patients.
Dr. Colombel and associates note that the clinical significance of these previously undetected lesions remains unknown, and they therefore recommend further prospective studies with more prolonged follow-up.
Gut 2006;55:978-982. Copyright © 2006 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.
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