Video capsule endoscopy in inflammatory bowel disease

Abstract

Over the last 8 years, capsule endoscopy (CE) has revolutionized the visualization of the small bowel. In 2004 this journal published "Capsule endoscopy in IBD: past, present and future" Kornbluth et al [2004] Inflamm Bowel Dis 10:278-285). In this article we review advances since that time and discuss whether CE has achieved its potential and what remaining goals it can and should hope to achieve. In the 2004 article we listed a series of clinical questions to be answered with regard to the use of capsule endoscopy We review those questions that have been addressed in the intervening 5 years, and also update those topics for which information was available at the time of the initial article.

Impact of capsule endoscopy on management of inflammatory bowel disease: A single tertiary care center experience

“…Different combinations, distributions, and numbers of aphthae, ulcers, erosions and strictures have been used to diagnose and assess CD (1,17,18) Because of the difficulties associated with using a gold-standard for the diagnosis of CD, we chose instead to study the management effects of CE on patients with previously diagnosed CD, as there was not a need to determine a cut-point for a diagnosis of CD. Instead, we studied the implications of the findings (whether regarded as positive or negative by the treating physician) on CE.…”

“…Capsule endoscopy (CE) (Given, Yoqnem, Israel; Pill-Cam SB) has been in use in the United States since 2001, as an important tool to evaluate the entire small bowel (1, 2). Since this time, several reports of the use of CE in single centers have been published.…”

“…CE can also be used to revise a diagnosis to CD in patients previously thought to have indeterminate colitis (IC) or in those with previous colectomy who have an ileal pouch anal anastamosis (IPAA) and continued symptoms (symptomatic pouchitis) (11-13). However, the clinical utility of CE in the specific management of any of these subtypes of previously diagnosed IBD is not currently known (1). …”

Capsule Endoscopy: Strategies and Pitfalls of Interpretation

“…Five of the 9 patients had subsequent histologic findings in agreement the clinical diagnosis of Crohn's disease. There are several potential indications for performing VCE in patients with IBD: Suspected Crohn's disease with negative findings on upper GI endoscopy and colonoscopy, evaluation of OGIB in patients with Crohn's disease, evaluation of disease extent in patients with Crohn's disease, if such information is likely to alter patient management, evaluation of postoperative recurrence, evaluation of patients with indeterminate colitis, evaluation of response to antiinflammatory therapy, if clinically indicated (Di Nardo et al, 2011;Swaminath et al, 2010). However, contraindications for patients to have VCE include having a known or suspected gastrointestinal tract obstruction and/or known small bowel strictures , because of the increased risk of capsule retention in patients with Crohn's disease.…”

Capsule and Balloon Endoscopy: When Are They Really Needed in Patients with Inflammatory Bowel Diseases?

“…The incremental yield of CE seems mainly to be due to the detection of small lesions such as aphthous lesions or erosions, since moderate to severe inflammation in the small bowel is generally found on CTE or MRE [12,13] . There are still no studies of CE demonstrating a significant therapeutic impact of the test, or allowing for prediction of response to therapy in IBD based solely on its results [14] .…”