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 26 May 2018

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Endoscopy superior for non-stricturing small bowel Crohn's diagnosis

Capsule endoscopy is superior to all other modalities for diagnosing non-stricturing small bowel Crohn's, but techniques are similar in diagnosing suspected initial presentation of Crohn's, finds May's American Journal of Gastroenterology.

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Capsule endoscopy allows for direct evaluation of the small bowel mucosa in patients with Crohn's disease.

A number of studies have revealed significantly improved yield for capsule endoscopy over other modalities for the diagnosis of Crohn's disease.

However, the sample sizes have been small, and the true degree of benefit is uncertain.

It is also not clear whether patients with a suspected initial presentation of Crohn's disease, and those with suspected recurrent disease benefit equally from capsule endoscopy.

Dr Virender Sharma and colleagues evaluated the yield of capsule endoscopy in patients with Crohn's disease.

The research team compared capsule endoscopy with other modalities in symptomatic patients with suspected or established Crohn's disease.

The team used meta-analysis, and performed a recursive literature search of prospective studies.

Data on yield among various modalities were extracted, pooled, and analyzed.

The yield for capsule endoscopy was 69% vs 30% with computed tomography
American Journal of Gastroenterology

Incremental yield and 95% confidence intervals of capsule endoscopy over comparative modalities were calculated.

Subanalyses of patients with a suspected initial presentation of Crohn's disease, and those with suspected recurrent disease were also performed.

The team identified 9 studies including 250 subjects that compared the yield of capsule endoscopy with small bowel barium radiography for diagnosing Crohn's.

The yield for capsule endoscopy versus barium radiography for all patients was 63% and 23%, respectively.

The researchers noted that 4 trials with 114 subjects compared the yield of capsule endoscopy to colonoscopy with ileoscopy.

The yield for capsule endosocpy versus ileoscopy for all patients was 61% and 46%, respectively.

The team found 3 studies with 93 subjects that compared the yield of capsule endoscopy to computed tomography enterography/enteroclysis.

The researchers observed that the yield for capsule endoscopy versus computed tomography for all patients was 69% and 30%, respectively.

There were 2 trials that compared capsule endoscopy to push enteroscopy.

A further trial compared capsule endoscopy to small bowel magnetic resonance imaging.

Subanalysis of patients with a suspected initial presentation of Crohn's showed no significant difference between the yield of capsule endoscopy and barium radiography.

The team also observed no difference between capsule endosocpy, and colonoscopy with ileoscopy or computed tomography enterography.

No difference was found between capsule endoscopy, and push enteroscopy.

Subanalysis of patients with established Crohn's and suspected small bowel recurrence showed a difference in yield in favor of capsule endoscopy.

Dr Sharma's team commented, “In study populations, capsule endoscopy is superior to all other modalities for diagnosing non-stricturing small bowel Crohn's disease.”

“The number needed to test to yield 1 additional diagnosis of Crohn's with small bowel barium radiography is 3, and 7 for colonoscopy with ileoscopy.”

“These results are due to a highly significant incremental yield with capsule endoscopy over all other modalities in patients with established non-stricturing Crohn's being evaluated for a small bowel recurrence.”

“There was no significant difference seen between capsule endoscopy and alternate modalities for diagnosing small bowel Crohn's disease in patients with a suspected initial presentation of Crohn's”

“However, the trend toward significance for a number of modalities suggests the possibility of a type II error.”

“Larger studies are needed to better establish the role of capsule endoscopy for diagnosing small bowel Crohn's disease in patients with a suspected initial presentation of Crohn's disease”.

Am J Gastroenterol 2006: 101(5): 954
17 May 2006

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