Capsule endoscopy allows visualization of the mucosa of the entire small bowel.
It is potentially important tool in the evaluation of patients with known or suspected Crohn's disease.
However, small bowel strictures, which are not uncommon in Crohn's, are considered to be a contraindication to capsule endoscopy for fear of capsule retention.
Dr Adam Cheifetz and colleagues from Massachusetts determined the risk of capsule retention in patients with suspected or known Crohn's disease.
The research team retrospectively reviewed the records of 983 capsule endoscopy cases.
|2% with suspected Crohn's had a retained capsule|
|American Journal of Gastroenterology|
The capsule endoscopy was performed at 3 private gastroenterology practices between 2000 and 2003.
A total of 102 cases were identified in which capsule endoscopy was used in 64 patients with suspected or 38 known Crohn's disease.
Only about 2% with suspected Crohn's disease had a retained capsule.
However, the team found that 13% of patients with known Crohn's, only 5 cases, the capsule was retained proximal to a stricture.
Of the 5 cases of retained capsules, the researchers observed that 3 strictures were previously unknown.
In 4 cases, the obstructing lesions were resected without complications, leading to complete resolution of the patient's underlying symptoms.
The researchers noted that 1 patient chose not to undergo surgery.
This patient has remained without an episode of small bowel obstruction for over 38 months.
Dr Cheifetz's team concludes, “Capsule retention occurred in 13% of patients with known Crohn's disease, but only in less than 2% with suspected Crohn's.”
“A retained capsule may indicate unsuspected strictures in Crohn's that may require an unexpected, but therapeutic, surgical intervention.”
“Patients and physicians should be aware of these potential risks when using capsule endoscopy in Crohn's disease.”