Small bowel capsule endoscopy vs conventional techniques in patients with symptoms highly compatible with Crohn's Disease

Background & aims: The diagnostic role of Small Bowel Capsule Endoscopy (SBCE) in Crohn's Disease (CD) is under investigation. In a prospective study we investigated the diagnostic role of SBCE in patients with symptoms highly compatible with CD and undefined diagnosis after conventional techniques. Methods: From September 2005 to May 2009, all patients with clinically suspected CD and not conclusive diagnosis after Ileocolonoscopy (IC), Small Bowel Follow Through (SBFT) and Small Intestine Contrast Ultrasonography (SICUS) were enrolled. Findings compatible with CD included: bowel wall thickness (BWT) > 3. mm (for SICUS), ulcers, stenosis/strictures, fistulae (for SICUS, SBFT); > 5 aphtoid ulcers, deep ulcers and/or strictures (for SBCE). Results: Conventional techniques did not lead to a conclusive diagnosis in 30 patients (19 F, median age 31. years, range 8-57), showing chronic diarrhoea (n = 27), abdominal pain (n = 23), weight loss (n = 5), fever (n = 5), Iron Deficiency Anaemia (IDA)(n = 5) and/or perianal disease (n = 4). Findings compatible but not diagnostic for small bowel CD were detected in 19 (63%) by IC in 12 (40%) by SICUS and in 15 (50%) by SBFT. SBCE showed ileal lesions in 15 (50%) patients, including findings compatible with CD in 12 (40%). SBCE retention requiring surgery was observed in 1 patient. A significant concordance was observed between SBCE and IC k = 0.33 C(k) = [0.25;0.42], but not between SBCE and SICUS k = 0.13 IC(k) = [0.045;0.22] and between SBCE and SBFT k = 0 IC(k) = [-0.089;0.089]. Conclusions: SBCE may detect lesions compatible with small bowel CD in almost one third of patients with symptoms highly compatible with CD and not conclusive diagnosis by using conventional techniques.