Capsule Endoscopy Detects Crohn's Recurrence After Surgery

VALENCIA, Spain, Sept. 27 -- Capsule endoscopy diagnosed more patients with Crohn's disease recurrence after surgery than did colonoscopy and was better tolerated, researchers here reported.

As a result, therapeutic management was modified for more than half the patients, Vicente Pons Beltrn, M.D., Ph.D., of La Fe University Hospital here, and colleagues, reported in the September issue of Gastrointestinal Endoscopy.

Compared with colonoscopy, capsule endoscopy identified disease recurrence in 62% of patients, whereas colonoscopy found inflammatory lesions in only 25%.

The capsule procedure can visualize the entire small intestine, including the upper parts that colonoscopy is not designed to reach, the researchers said.

In capsule endoscopy, the patient swallows a pill containing a tiny camera. As it travels through the body, the camera captures images of the gastrointestinal tract and transmits them to a computer viewed by the physician. The capsule is eventually excreted.

The researchers undertook a prospective study of 24 Crohn's patients seen from October 2003 to October 2005 at La Fe University Hospital. The patients had undergone ileocolonic resection with side-to-side anastomosis six months earlier and were asymptomatic.

All patients had a colonoscopy, although it was not possible to intubate the neoileum in three patients because of technical difficulties, the researchers said. No complications occurred in any of the patients during colonoscopy.

The patients also had M2A Patency Capsule imaging to verify the absence of strictures in the GI tract.

Capsule excretion was delayed in two patients, so that 22 patients received capsule endoscopy within two weeks of the patency procedure, and the complete small bowel was visualized in 21 patients. Visualization failed for one patient because of an electronic-system failure.

Recurrence was detected in only six (25%) of the patients whose neoileum was explored with colonoscopy and in five after capsule endoscopy. None had Crohn's disease in the colon.

Ten additional recurrences were visualized only with capsule endoscopy for a total of 15 inflammatory lesions (62%).

In addition, the researchers said, there was proximal involvement in the jejunum in 13 patients, one of whose duodenum was also affected by Crohn's. No false-negatives were found.

All patients preferred the capsule procedure to colonoscopy, although the differences were not significant, the investigators said.

Bowel preparation for the colonoscopy interfered with the patient's daily activity to a greater degree than did the liquid-diet preparation for the capsule procedure.

Fifty percent of the patients considered the ileocolonoscopy uncomfortable and eight patients required sedation or analgesia during the procedure. None of the patients considered capsule endoscopy to be uncomfortable, the researchers said.

On the basis of the findings, therapeutic strategies were re-evaluated for 16 patients (six detected by both procedures and 10 by capsule endoscopy alone). Three of the 10 patients rejected the suggested modification, whereas the others consented to immunosuppressive maintenance therapy.

Capsule endoscopy, the researchers said, is a useful tool for detecting both Crohn's recurrence and previously undetected small bowel involvement.

This was evidence enough to recommend a change in therapy for 42% of patients, in contrast to ileocolonoscopy, which considered alone would recommend change for only 25%.

Currently the main reason for a therapy change is the detection of more extensive recurrent lesions, but the investigators said that the clinical relevance of proximal lesions found with capsule endoscopy needs to be further assessed.

One possible limitation of the study, the researchers noted, was the side-to-side reconstitution of the neoilium, which made colonoscopy more difficult than an end-to-end anastomosis. This technique, which the surgeons at the Spanish center preferred, may have limited the evaluation, the researchers noted.