Utility of panenteric capsule endoscopy for the detection of small‐bowel Crohn's disease in patients with a normal magnetic resonance enterography: A prospective observational pilot study

Abstract

AbstractBackground and AimCapsule endoscopy allows the direct visualization of the small bowel. We examined the diagnostic utility of a new modality, namely panenteric Crohn's capsule endoscopy (CE), in detecting active small‐bowel Crohn's disease (CD) in those with normal magnetic resonance enterography (MRE).MethodsWe prospectively recruited patients with a diagnosis of CD or suspected small‐bowel CD in whom the MRE was normal. Inclusion criteria included abdominal symptoms and abnormal serum or fecal biomarkers. The primary outcome was the detection of active small‐bowel CD (measured through the Lewis score [LS]). Secondary outcomes included change in Montreal classification for those with a pre‐existing CD diagnosis, change in medical therapy, clinical activity, and biomarkers at baseline and 6 months, and quality‐of‐life measures.ResultsA total of 22 patients with a diagnosis of CD or suspected new diagnosis were recruited, with CE complete to the caecum in 21 and 18/21 (86%) showing evidence of active small‐bowel CD (LS > 135). Of the patients with a pre‐existing diagnosis of CD, 9/11 (82%) had a change in Montreal classification. At 6 months following CE, 17/18 (94%) had clinician‐directed change in therapy. This correlated with an improvement in the quality of life (P < 0.05 as per the Short Inflammatory Bowel Disease Questionnaire), a reduction in the Harvey Bradshaw index (median: 7–4, P < 0.001), and favorable CRP and albumin response.ConclusionCrohn's CE is a useful diagnostic test for assessing active small‐bowel CD when imaging is normal but clinical suspicion is high. Crohn's CE should be integrated into the diagnostic algorithm for small‐bowel CD.