Is Effective of Capsule Endoscopy Compared to Other Diagnostic Modalities in Patients with Small Bowel Crohn’s Disease?

Crohn's disease (CD) is a chronic inflammatory disorder associated with both mucosal and transmural inflammation of the bowel wall, involving mainly the small intestine and the colon, but possibly the entire gastrointestinal tract as well as other organs. 1 Small bowel involvement occurs in about 70% of CD patients, with up to 30% patients presenting with disease limited to the ileum. 2,3 Currently, there is no gold standard for diagnosing small bowel CD. Evaluation of the small intestine with barium radiography is limited by the relative insensitivity for detection of early inflammatory lesions, and endoscopic evaluation is confined to the most distal and proximal small bowel alone. There are a growing number of reports comparing capsule endoscopy (CE) with other diagnostic tests for use in patients with small bowel CD. CE has been prospectively evaluated in the diagnosis of nonstricturing small bowel CD, as compared with small bowel follow-through (SBFT), ileocolonoscopy (IC), push enteroscopy (PE), enteroclysis (EC), computed tomography enterography (CTE) and magnetic resonance enterography (MRE) with most results showing a significant improvement in diagnostic yield with CE. Meta-analysis of CE in CD has been conducted previously. Triester et al. 2 reported that CE is superior to barium radiography and IC for nonstricturing small bowel CD; whereas, CE showed no significant difference, as compared to alternate diagnostic modalities in patients initially presenting with suspected CD. Di-onisio et al. 9 reported diagnostic yield in patients with suspected and confirmed small-bowel CD, indicating that CE was superior to SBFT, CTE and IC in the evaluation of suspected CD patients. CE was also a more effective diagnostic tool in established CD patients, as compared with SBFT, CTE, and PE. In this issue of Gut and Liver, Choi et al. 10 reported results from meta-analysis with published original articles only. After excluding preclinical studies and articles such as reviews, editorials , letters, abstracts, and comment, 24 articles were finally included in the study. Cases were divided into suspected and confirmed CD. The primary outcome was diagnostic yield and diagnostic accuracy of CE. Patient satisfaction, therapeutic impact on treatment, and additional diagnostic information gain in comparison to other modalities were evaluated as secondary outcomes. Quality Assessment of Diagnostic Accuracy Studies-II tool was used to determine the risk of bias. Applicability of concerns for individual studies was graded as low, high, or unclear. Diagnostic modality of detecting lesions of suspected CD was much higher with CE, …