Abstract
Background and study aims Pan-enteric capsule endoscopy (CE) is
an emerging alternative to ileo-colonoscopy for diagnosing Crohn’s disease (CD). However, CE
does not offer the opportunity to take biopsies to support the diagnosis. This study examined
the additional information obtained with mucosal biopsies and the feasibility of CE as a
single diagnostic procedure.
Patients and methods This retrospective study was based on a
prospective, blind multicenter trial in which patients with suspected CD were examined with
ileo-colonoscopy plus segmental biopsies and CE. Histopathological findings were compared to
the result of CE.
Results A total of 107 patients with a complete CE were included
in the analysis. CE was consistent with CD in 44 patients (41.1%) and ulcerative colitis in 10
patients (9.3%). Histopathology confirmed the result of CE in 39.3% of patients and added new
diagnostic information in 6.5% of patients. A CE consistent with CD was histologically
confirmed in 20.5% of patients. Biopsies most often showed non-specific inflammation (61.4%).
Only one patient with a normal CE had a specific histological diagnosis (microscopic colitis).
Biopsies altered the diagnosis of ulcerative colitis to CD in two patients, and in two
patients with a normal CE, biopsies showed CD or ulcerative colitis. In one patient with
lymphoma in the terminal ileum and cecum, CE was misinterpreted as CD.
Conclusions In patients with suspected CD and an evident result
of CE, the additional information obtained from biopsies is limited, and CE as a single
diagnostic procedure might be feasible in selected patients. Biopsies are warranted, however,
in patients with an atypical endoscopic appearance or suspected malignancy.
Keywords
Endoscopy Lower GI Tract - Endoscopy Small Bowel - Inflammatory bowel disease - Capsule endoscopy - Tissue diagnosis
