Evaluation of postsurgical recurrence in Crohn's disease: a new indication for capsule endoscopy?

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doi:10.1016/j.gie.2006.12.059 Copyright © 2007 American Society for Gastrointestinal Endoscopy Published by Mosby, Inc.

Original Article

Evaluation of postsurgical recurrence in Crohn's disease: a new indication for capsule endoscopy?

Gastrointestinal Endoscopy Volume 66, Issue 3, September 2007, Pages 533-540 MD, PhD, a, Pilar Nos MD, PhDa, Guillermo Bastida MDa, Belén Beltrán MD, PhDa, Lidia Argüello MDa, m Aguas MDa, Angel Rubín MDa, Virginia Pertejo MD, PhDa and Sala MD, PhDa aCurrent affiliations: Gastroenterology Unit, La Fe University Hospital, Valencia, Spain Received 17 August 2006; accepted 26 December 2006. Valencia, Spain. Available online 26 August 2007. Background

Recurrence after surgery to treat Crohn's disease is frequent and unpredictable. The efficacy of postsurgery capsule endoscopy in detecting recurrence in patients with Crohn's disease is yet to be confirmed. Objective To assess the safety, accuracy, and therapeutic impact of capsule endoscopy in these patients. Design Crohn's disease recurrence at the neoileum (Rutgeers score) was assessed in the patients by colonoscopy and capsule endoscopy. The M2A Patency Capsule (Given Imaging, Yoqneam, Israel) was administered 1 week before capsule endoscopy. Capsule endoscopy was performed within 2 weeks of colonoscopy. Investigators were blinded to the results of each technique. Patient comfort during the procedures was recorded. Patients Twenty-four patients with Crohn's disease with ileocolonic anastomosis were prospectively included. All patients were asymptomatic and did not receive any prophylactic treatment. Main Outcome Measurements Neoileum recurrence. Results A colonoscopy was performed in all patients, although the neoileum could not be reached in 3 of them. M2A Patency Capsule excretion was delayed in 2 patients; thus capsule endoscopy was given only to 22 patients. Recurrence was visualized with colonoscopy in 6 patients and with capsule endoscopy in 5. Ten additional recurrences were visualized only with capsule endoscopy. Moreover, proximal involvement was detected in 13 patients. Therapeutic management was modified in 16 patients. All patients preferred capsule endoscopy. Conclusions Capsule endoscopy is more effective in the evaluation of recurrence after surgery for Crohn's disease and is better tolerated than colonoscopy. This is of significant therapeutic relevance. Abbreviations: CD, Crohn's disease; CE, capsule endoscopy

Reprint requests: Vicente Pons, MD, PhD, Servicio de Medicina Digestiva, Hospital Universitari La Fe, Avda Campanar 21, 46009, Valencia, Spain.

Gastrointestinal Endoscopy Volume 66, Issue 3, September 2007, Pages 533-540