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 25 February 2018

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News

Videocapsule endoscopy vs barium contrast for diagnosis of Crohn's

A recent report in the American Journal of Gastroenterology reports that VCE and SBFT are complementary for the diagnosis of Crohn's disease, however VCE is less invasive, less time-consuming for the patient than SBFT, and avoids radiation exposure.

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Historically, suspected Crohn's disease (CD) has been evaluated with small bowel follow-through (SBFT) or enteroclysis (equally accurate).

Dr Buchman and colleagues from America undertook a study to determine the accuracy of videocapsule endoscopy (VCE) in the diagnosis of CD relative to SBFT and clinical/laboratory indices of CD activity.

This is the first study to evaluate the occurrence of active disease in patients with known CD.

Researchers included 30 subjects in total into the study (22 female, 8 male, aged 36.9 ± 14.2 yr).

All of the participants had a prior CD diagnosis made on the basis of standard criteria (5.5 ± 6.5 yr prior to study), and recurrent CD was suspected based on abdominal pain, diarrhea, anemia, and/or arthralgias.

The research team studied the subjects in a prospective, blinded evaluation of VCE versus SBFT.

The investigators performed SBFT first.

Those with stricture and proximal bowel dilation were excluded from further study.

SBFT found mucosal disease in 20 of 30 patients and VCE found mucosal disease in 21 of 30 patients
American Journal of Gastroenterology

For SBFT, the research team graded the studies as:

Grade 0 (normal),
Grade 1 (minimal nodularity, ulcerations, normal luminal diameter, < 5 cm involved),
Grade 2 (more extensive ulcers, minimal luminal narrowing, 510 cm involved),
or Grade 3 (fistula, skip areas, extensive ulceration, >10 cm involved).

VCE was performed within 1 wk of SBFT.

VCE (digitalized video) was graded as:

Grade 0 (normal),
Grade 1 (erythema, isolated villi loss),
Grade 2 (erosion, no ulcer), or
Grade 3 (ulcers, spontaneous bleeding, and/or stricture).

The researchers excluded 12 patients for small bowel obstruction.

The research team visualized active CD in 21 of 30 patients with videocapsule endoscopy and in 20 of 30 patients with SBFT.

The researchers found that VCE and SBFT scores correlated highly. They found that there was complete agreement in 13 of 30 studies and 13 of 17 studies differed by one grade.

SBFT found mucosal disease in 20 of 30 patients and VCE found mucosal disease in 21 of 30 patients.

Patient satisfaction was superior for VCE.

Dr Buchman concluded, "VCE and SBFT are complementary for the diagnosis of CD."

"SBFT may be required to detect strictures as the videocapsule may not pass. However, some strictures may also be missed with SBFT."

"VCE is less invasive, less time-consuming for the patient than SBFT, and avoids radiation exposure, although reading time is greater for the gastroenterologist than the radiologist."

American Journal of Gastroenterology; 2004: 99 (11): 2171
17 November 2004

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