Capsule endoscopy in patients with Crohn's disease: diagnostic yield and safety

Background: Capsule endoscopy (CE) is increasingly used in patients with suspected or known Crohn's disease (CD). Objective: To determine the diagnostic yield of CE and the distribution of small-bowel (SB) lesions in symptomatic patients with known CD. Design and Setting: Retrospective review of CE procedures performed in patients with CD between 2001 and 2005 in a tertiary care center. Patients: One hundred thirty-four patients with an established diagnosis of CD and symptoms suggestive of active disease. Interventions: Swallowing the capsule. Main Outcome Measurements: Diagnostic yield of CE and distribution of SB lesions in patients with CD. Results: One hundred forty-six CE procedures were performed on 134 CD patients. Fifty-two (39%) of 134 patients had CE findings diagnostic of active CD (>3 ulcerations), and 17 (13%) had findings suggestive of active CD (≤3 ulcerations). Fifty-seven (42%) patients had normal findings, and 6% had normal but incomplete studies. The distribution of SB lesions was 32% in the duodenum, 53% in the jejunum, 67% in the proximal ileum, and 85% in the distal ileum. CE was comparable to ileoscopy in detecting ileal ulcerations (55% vs 48%), but superior to SB follow-through in detecting CD lesions in the SB (incremental yield of 32%; 95% CI, 9%-54%; P = .0017). Limitations: Retrospective study from a single center. Conclusions: CE identified SB lesions in approximately half of symptomatic CD patients. Large-scale prospective studies are needed to evaluate whether positive CE findings may affect disease outcomes.