Background: Evaluating small bowel involvement in the diagnosis of Crohn's Disease, CD, is part of the standard work up for all new diagnosis. While this previously took the form of radiological imaging by CTE, MRE or small bowel follow through, small bowel capsule endoscopy, SBCE, now offers an additional means to diagnose and evaluate small bowel Crohn's Disease.
The aim of the study was to review the diagnostic yield of SBCE in the setting of IBD.
Methods: As part of a small bowel capsule endoscopy service review in Tallaght hospital, to date, 286 SBCE for diagnosis/assessment of small bowel CD have been included. Patients were categorised as known CD or suspected CD. Small bowel pathology was recorded. Rates of capsule retention and subsequent 30 day retention rates were analysed.
Results: The total cohort comprised of 286 SBCEs. Demographics included; median age – 41 years, female – 174 (60.8%). 48 and 238 patients had CD and suspected CD, respectively. 108/286 SBCES were reported as normal which comprised of 14.5% of CD cohort compared to 42.4% of suspected CD patients. Positive findings included – ileitis 94/286 (32.8%), strictures 17/286 (6%), fistulas 3/286 (1%), gastritis 43/286 (15%), non-specific enteritis 41/286 (14%), polyps 6/286 (2%), submucosal lesion 4/286 (1%) and fresh blood 4/286 (1%). 16 (2%) capsules in total were retained at time of reporting – 9 were retained in the small bowel and 7 were retained in the stomach. 8/16 (50%) had a previous successful patency capsule. Subsequent follow up available of 12/16 patients confirmed subsequent spontaneous passage of capsule.
Conclusions: The diagnostic yield for SBCE is higher in patients with known CD than suspected CD patients. However, over 50% of patients with suspected CD had pathology on SBCE. The rate of capsule retention was relatively low with no retrieval of capsule required by either double balloon endoscopy or laparotomy to our knowledge. SBCE is a useful and safe tool for the assessment of small bowel pathology in addition to radiological imaging.