Abstract
Background
Capsule endoscopy (CE) has proven to be highly effective at detecting small bowel lesions, but studies regarding the diagnostic impact of CE on ileitis are rare.
Aims
We evaluated the diagnostic value of small bowel CE for isolated ileitis observed during ileocolonoscopy.
Methods
The CE results in 137 patients initially diagnosed with ileitis without colonic mucosal abnormalities on ileocolonoscopy at one of eight tertiary referral centers between October 2002 and June 2015 were retrospectively analyzed.
Results
Among the 137 patients with isolated ileitis observed on ileocolonoscopy, 117 (85.4%) revealed positive small bowel CE findings (85.4%). The rate of positive small bowel CE findings was 92.9% in cases of ileal aphthous ulcer or erosion, and 90.9% in cases of ileal ulcer. Among 117 positive CE cases, the most common final diagnosis by CE was Crohn’s disease (CD) (n = 44, 32%). No findings were identified in 20 (14.6%) of 137 cases. Ileal erosion/ulcer, rather than findings such as nodularity and erythema or elevated erythrocyte sedimentation rate (ESR) (>10 mm/h), was significant predictive factors for positive CE findings in multivariate analysis.
Conclusions
Small bowel CE showed a high diagnostic yield (85.4%) in symptomatic patients with isolated ileitis on ileocolonoscopy. Erosion or ulcer of the small bowel was a common finding on CE (66.4%), and approximately one-third of patients were diagnosed with CD. In patients with isolated ileitis on ileocolonoscopy, CE should be considered to evaluate small bowel lesions when the patient shows an elevated ESR or when the ileitis manifests as ileal ulcer or erosion rather than a nodular or erythematous lesion.
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References
Bojica D, Markovicb S. Terminal ileitis is not always Crohn’s disease. Ann Gastroenterol. 2011;24:271–275.
Chang HS, Lee D, Kim JC, et al. Isolated terminal ileal ulcerations in asymptomatic individuals: natural course and clinical significance. Gastrointest Endosc. 2010;72:1226–1232.
Jeong SH, Lee KJ, Kim YB, et al. Diagnostic value of terminal ileum intubation during colonoscopy. J Gastroenterol Hepatol. 2008;23:51–55.
Kedia S, Kurrey L, Pratap Mouli V, et al. Frequency, natural course and clinical significance of symptomatic terminal ileitis. J Dig Dis. 2016;17:36–43.
Dilauro S, Crum-Cianflone NF. Ileitis: when it is not Crohn’s disease. Curr Gastroenterol Rep. 2010;12:249–258.
Lee HS, Lim YJ. Capsule endoscopy for ileitis with potential involvement of other sections of the small bowel. Gastroenterol Res Pract. 2016;2016:9804783.
Rex DK, Petrini JL, Baron TH, et al. Quality indicators for colonoscopy. Am J Gastroenterol. 2006;101:873–885.
Jensen MD, Nathan T, Kjeldsen J. Inter-observer agreement for detection of small bowel Crohn’s disease with capsule endoscopy. Scand J Gastroenterol. 2010;45:878–884.
Mehdizadeh S, Chen GC, Barkodar L, et al. Capsule endoscopy in patients with Crohn’s disease: diagnostic yield and safety. Gastrointest Endosc. 2010;71:121–127.
Van Assche G, Dignass A, Panes J, et al. The second European evidence-based consensus on the diagnosis and management of Crohn’s disease: definitions and diagnosis. J Crohns Colitis. 2010;4:7–27.
Gal E, Geller A, Fraser G, et al. Assessment and validation of the new capsule endoscopy Crohn’s disease activity index (CECDAI). Dig Dis Sci. 2008;53:1933–1937.
Ersoy O, Harmanci O, Aydinli M, et al. Capability of capsule endoscopy in detecting small bowel ulcers. Dig Dis Sci. 2009;54:136–141.
Triester SL, Leighton JA, Leontiadis GI, et al. A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with non-stricturing small bowel Crohn’s disease. Am J Gastroenterol. 2006;101:954–964.
Shim KN, Kim YS, Kim KJ, et al. Abdominal pain accompanied by weight loss may increase the diagnostic yield of capsule endoscopy: a Korean multicenter study. Scand J Gastroenterol. 2006;41:983–988.
Song HJ, Shim KN. Current status and future perspectives of capsule endoscopy. Intest Res. 2016;14:21–29.
Courville EL, Siegel CA, Vay T, et al. Isolated asymptomatic ileitis does not progress to overt Crohn disease on long-term follow-up despite features of chronicity in ileal biopsies. Am J Surg Pathol. 2009;33:1341–1347.
Sachar DB, Luppescu NE, Bodian C, et al. Erythrocyte sedimentation as a measure of Crohn’s disease activity: opposite trends in ileitis versus colitis. J Clin Gastroenterol. 1990;12:643–646.
Sachar DB, Smith H, Chan S, et al. Erythrocytic sedimentation rate as a measure of clinical activity in inflammatory bowel disease. J Clin Gastroenterol. 1986;8:647–650.
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Lee, H.S., Lim, Y.J., Shim, K.N. et al. Diagnostic Value of Small Bowel Capsule Endoscopy in Isolated Ileitis: A CAPENTRY Study. Dig Dis Sci 62, 180–187 (2017). https://doi.org/10.1007/s10620-016-4387-8
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DOI: https://doi.org/10.1007/s10620-016-4387-8