Diagnostic Yield of Colon Capsule Endoscopy for Crohn’s Disease Lesions in the Whole Gastrointestinal Tract

Abstract BACKGROUNDCrohn’s disease (CD) can involve the upper gastrointestinal (GI) tract as well as the small and large bowel. PillCam colon capsule endoscopy (PCCE-2) enables to observe the whole GI tract, but its diagnostic yield for CD lesions in the whole GI tract remains unknown. AIMTo elucidate the diagnostic yield of PCCE-2 in patients with CD.METHODSPatients with CD who underwent PCCE-2 and double-balloon endoscopy (DBE) using oral and anal approaches were evaluated for CD lesions in the whole GI tract. We divided the small bowel into three segments (jejunum, ileum, and terminal ileum), and the large bowel into four segments (right colon, transverse colon, left colon, rectum). Detection of ulcer scars, erosion, ulcers, bamboo joint-like appearance, and notch-like appearance was assessed in each segment. The diagnostic yield of PCCE-2 was analyzed based on the DBE results as the gold standard.RESULTSOf the total 124 segments, the sensitivities of PCCE-2 for ulcer scars, erosion, and ulcers were 83.3%, 93.8%, and 88.5%, respectively, and the specificities were 76.0%, 78.3%, and 81.6%, respectively. For the 60 small bowel segments, the sensitivities were 84.2%, 95.5%, and 90.0%, respectively, and the specificities were 63.4%, 86.8%, and 87.5%, respectively. For the 64 large bowel segments, the sensitivities were 80.0%, 90.0%, and 83.3%, respectively, and the specificities were 84.7%, 72.2%, and 77.6%, respectively.CONCLUSIONPCCE-2 provides a high diagnostic yield for lesions in the whole GI tract of patients with CD. Thus, we recommend its use as a pan-enteric tool in clinical settings.

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Diagnostic yield of colon capsule endoscopy for Crohn’s disease lesions in the whole gastrointestinal tract

BMC Gastroenterology ◽

10.1186/s12876-021-01657-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Keisaku Yamada ◽

Masanao Nakamura ◽

Takeshi Yamamura ◽

Keiko Maeda ◽

Tsunaki Sawada ◽

...

Keyword(s):

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Capsule Endoscopy ◽

Large Bowel ◽

Diagnostic Yield ◽

Gi Tract ◽

Colon Capsule Endoscopy ◽

Colon Capsule ◽

Bowel Segments

Abstract Background Crohn’s disease (CD) can involve the upper gastrointestinal (GI) tract as well as the small and large bowel. PillCam colon capsule endoscopy (PCCE-2) enables observation of the whole GI tract, but its diagnostic yield for CD lesions in the whole GI tract remains unknown. Aim To elucidate the diagnostic yield of PCCE-2 in patients with CD. Methods Patients with CD who underwent PCCE-2 and double-balloon endoscopy (DBE) using oral and anal approaches were evaluated for CD lesions in the whole GI tract. We divided the small bowel into three segments (jejunum, ileum, and terminal ileum), and the large bowel into four segments (right colon, transverse colon, left colon, rectum). Detection of ulcer scars, erosion, ulcers, bamboo joint-like appearance, and notch-like appearance was assessed in each segment. The diagnostic yield of PCCE-2 was analyzed based on the DBE results as the gold standard. Results Of the total 124 segments, the sensitivities of PCCE-2 for ulcer scars, erosion, and ulcers were 83.3%, 93.8%, and 88.5%, respectively, and the specificities were 76.0%, 78.3%, and 81.6%, respectively. For the 60 small bowel segments, the sensitivities were 84.2%, 95.5%, and 90.0%, respectively, and the specificities were 63.4%, 86.8%, and 87.5%, respectively. For the 64 large bowel segments, the sensitivities were 80.0%, 90.0%, and 83.3%, respectively, and the specificities were 84.7%, 72.2%, and 77.6%, respectively. Conclusion PCCE-2 provides a high diagnostic yield for lesions in the whole GI tract of patients with CD. Thus, we recommend its use as a pan-enteric tool in clinical settings.

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Capsule Endoscopy in Inflammatory Bowel Disease: When? To Whom?

Diagnostics ◽

10.3390/diagnostics11122240 ◽

2021 ◽

Vol 11 (12) ◽

pp. 2240

Author(s):

Soo-Young Na ◽

Yun-Jeong Lim

Keyword(s):

Small Bowel ◽

Capsule Endoscopy ◽

Diagnostic Yield ◽

Postoperative Recurrence ◽

Treat To Target ◽

Diagnostic Modality ◽

Colon Capsule Endoscopy ◽

Bowel Diseases ◽

Colon Capsule ◽

The Cost

Capsule endoscopy (CE) has proven to be a valuable diagnostic modality for small bowel diseases over the past 20 years, particularly Crohn’s disease (CD), which can affect the entire gastrointestinal tract from the mouth to the anus. CE is not only used for the diagnosis of patients with suspected small bowel CD, but can also be used to assess disease activity, treat-to-target, and postoperative recurrence in patients with established small bowel CD. As CE can detect even mildly non-specific small bowel lesions, a high diagnostic yield is not necessarily indicative of high diagnostic accuracy. Moreover, the cost effectiveness of CE as a third diagnostic test employed usually after ileocolonoscopy and MR or CT enterography is an important consideration. Recently, new developments in colon capsule endoscopy (CCE) have increased the utility of CE in patients with ulcerative colitis (UC) and pan-enteric CD. Although deflation of the colon during the examination and the inability to evaluate dysplasia-associated lesion or mass results in an inherent risk of overestimation or underestimation, the convenience of CCE examination and the risk of flare-up after colonoscopy suggest that CCE could be used more actively in patients with UC.

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Diagnostic Yields and Clinical Impacts of Capsule Endoscopy

Diagnostics ◽

10.3390/diagnostics11101842 ◽

2021 ◽

Vol 11 (10) ◽

pp. 1842

Author(s):

Seung Min Hong ◽

Sung Hoon Jung ◽

Dong Hoon Baek

Keyword(s):

Small Bowel ◽

Capsule Endoscopy ◽

Diagnostic Yield ◽

Critical Role ◽

Current Status ◽

Entire Small Bowel ◽

Colon Capsule Endoscopy ◽

Bowel Diseases ◽

Colon Capsule ◽

Bowel Disorders

Observing the entire small bowel is difficult due to the presence of complex loops and a long length. Capsule endoscopy (CE) provides a noninvasive and patient-friendly method for visualizing the small bowel and colon. Small bowel capsule endoscopy (SBCE) has a critical role in the diagnosis of small bowel disorders through the direct observation of the entire small bowel mucosa and is becoming the primary diagnostic tool for small bowel diseases. Recently, colon capsule endoscopy (CCE) was also considered safe and feasible for obtaining sufficient colonic images in patients with incomplete colonoscopy, in the absence of bowel obstruction. This review article assesses the current status of CE in terms of the diagnostic yield and the clinical impact of SBCE in patients with obscure gastrointestinal bleeding, who have known or suspected Crohn’s disease, small bowel tumor and inherited polyposis syndrome, celiac disease, and those who have undergone CCE.

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Diagnostic yield of magnetically assisted capsule endoscopy versus gastroscopy in recurrent and refractory iron deficiency anemia

Endoscopy ◽

10.1055/a-0750-5682 ◽

2018 ◽

Vol 51 (05) ◽

pp. 409-418 ◽

Cited By ~ 10

Author(s):

Hey-Long Ching ◽

Melissa F. Hale ◽

Matthew Kurien ◽

Jennifer A. Campbell ◽

Stefania Chetcuti Zammit ◽

...

Keyword(s):

Small Bowel ◽

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Capsule Endoscopy ◽

Diagnostic Yield ◽

Deficiency Anemia ◽

Gi Tract ◽

Upper Gi ◽

Upper Gi Tract ◽

Magnetically Assisted

Abstract Background Small-bowel capsule endoscopy is advocated and repeat upper gastrointestinal (GI) endoscopy should be considered for evaluation of recurrent or refractory iron deficiency anemia (IDA). A new device that allows magnetic steering of the capsule around the stomach (magnetically assisted capsule endoscopy [MACE]), followed by passive small-bowel examination might satisfy both requirements in a single procedure. Methods In this prospective cohort study, MACE and esophagogastroduodenoscopy (EGD) were performed in patients with recurrent or refractory IDA. Comparisons of total (upper GI and small bowel) and upper GI diagnostic yields, gastric mucosal visibility, and patient comfort scores were the primary end points. Results 49 patients were recruited (median age 64 years; 39 % male). Combined upper and small-bowel examination using the new capsule yielded more pathology than EGD alone (113 vs. 52; P < 0.001). In upper GI examination (proximal to the second part of the duodenum, D2), MACE identified more total lesions than EGD (88 vs. 52; P < 0.001). There was also a difference if only IDA-associated lesions (esophagitis, altered/fresh blood, angioectasia, ulcers, and villous atrophy) were included (20 vs. 10; P = 0.04). Pathology distal to D2 was identified in 17 patients (34.7 %). Median scores (0 – 10 for none – extreme) for pain (0 vs. 2), discomfort (0 vs. 3), and distress (0 vs. 4) were lower for MACE than for EGD (P < 0.001). Conclusion Combined examination of the upper GI tract and small bowel using the MACE capsule detected more pathology than EGD alone in patients with recurrent or refractory IDA. MACE also had a higher diagnostic yield than EGD in the upper GI tract and was better tolerated by patients.

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Colon Capsule Endoscopy vs. CT Colonography Following Incomplete Colonoscopy: A Systematic Review with Meta-Analysis

Cancers ◽

10.3390/cancers12113367 ◽

2020 ◽

Vol 12 (11) ◽

pp. 3367

Author(s):

Ulrik Deding ◽

Lasse Kaalby ◽

Henrik Bøggild ◽

Eva Plantener ◽

Mie Kruse Wollesen ◽

...

Keyword(s):

Capsule Endoscopy ◽

Diagnostic Yield ◽

Meta Analysis ◽

Rate Sensitivity ◽

Completion Rate ◽

Polyp Detection ◽

Proximal Point ◽

Incomplete Colonoscopy ◽

Colon Capsule Endoscopy ◽

Colon Capsule

Following incomplete colonoscopy (IC) patients often undergo computed tomography colonography (CTC), but colon capsule endoscopy (CCE) may be an alternative. We compared the completion rate, sensitivity and diagnostic yield for polyp detection from CCE and CTC following IC. A systematic literature search resulted in twenty-six studies. Extracted data included inter alia, complete/incomplete investigations and polyp findings. Pooled estimates of completion rates of CCE and CTC and complete colonic view rates (CCE reaching the most proximal point of IC) of CCE were calculated. Per patient diagnostic yields of CCE and CTC were calculated stratified by polyp sizes. CCE completion rate and complete colonic view rate were 76% (CI 95% 68–84%) and 90% (CI 95% 83–95%). CTC completion rate was 98% (CI 95% 96–100%). Diagnostic yields of CTC and CCE were 10% (CI 95% 7–15%) and 37% (CI 95% 30–43%) for any size, 13% (CI 95% 9–18%) and 21% (CI 95% 12–32%) for >5-mm and 4% (CI 95% 2–7%) and 9% (CI 95% 3–17%) for >9-mm polyps. No study performed a reference standard follow-up after CCE/CTC in individuals without findings, rendering sensitivity calculations unfeasible. The increased diagnostic yield of CCE could outweigh its slightly lower complete colonic view rate compared to the superior CTC completion rate. Hence, CCE following IC appears feasible for an introduction to clinical practice. Therefore, randomized studies investigating CCE and/or CTC following incomplete colonoscopy with a golden standard reference for the entire population enabling estimates for sensitivity and specificity are needed.

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