When Crohn′s disease is in remission, more patients complete capsule endoscopy study but less lesions are identified

Background and Aims: Wireless capsule endoscopy (WCE) is used in Crohn′s disease (CD) to define disease extent. We aimed to define WCE detection rate of small bowel ulcerative lesions and completion rate in CD patients. Patients and Methods: A total of 102 consecutive CD patients, who successfully passed patency capsule, were matched to 102 controls. WCE was performed in both patients (in acute phase and CD clinical remission) and controls. Results: Eighty-six (84%) controls versus 62 (61%) patients in the acute phase ( P = 0.003) and 96 (94%) in remission ( P = 0.02) completed WCE study. Gastric passing time was 48 ± 66 min in controls, 66 ± 82 min in CD acute phase ( P = 0.03) and 30 ± 21 min in remission ( P = 0.07). Small bowel passing time was 276 ± 78 min in controls, 299 ± 78 min in the acute phase of CD ( P = 0.04) and 248 ± 89 min in remission ( P = 0.01). Mean capsule endoscopy Crohn′s disease activity index (CECDAI) score was 14 ± 6 in acute small bowel CD, 12 ± 7 in acute small-large bowel CD ( P = 0.08) and 2 ± 2 in both CD types while in remission ( P = 1.00). Small bowel ulcerative lesions in the acute phase were more frequently in distal small bowel. Aphthous ulcers were frequent a month after entering clinical remission and tend to disappear gradually later on. No ulcerative lesions were present in deep remission. Patency capsule is rather safe to exclude small bowel obstruction. Conclusions: (1) A high percentage of patients with active CD do not complete small bowel study with WCE. (2) Small bowel ulcerative lesions in clinical remission were less severe, although at least 6 months are needed in order for them to disappear

PillCam Colon capsule endoscopy does not always complement incomplete colonoscopy

Background: There are no data on the role of PillCam Colon capsule (PCC) endoscopy for examination of the colon in incomplete colonoscopy cases. Objective: To evaluate whether PCC endoscopy can complete colon examination after failure of conventional colonoscopy to visualize the cecum. Setting: Three tertiary centers. Study design: Retrospective case series. Patients: Patients who underwent PCC endoscopy after incomplete colonoscopy from January to June 2008. Interventions: Conventional colonoscopy and PCC endoscopy. Results: By using PCC, we studied 12 patients who had incomplete colonoscopy Six patients had an obstructing tumor of the left side of the colon, and, in 6 cases, there were technical difficulties to complete colonoscopy PCC endoscopy visualized the rectum in 1 case. The capsule did not reach the site where colonoscopy stopped in 6 of the 12 cases, ie, 3 left sited tumors and 3 with technical difficulties. Moreover, in 1 of the 3 cases in which the capsule passed the site where colonoscopy stopped, poor bowel preparation precluded the accurate examination of the colon. Four patients underwent a third colon examination (3 barium enemas and 1 virtual CT colonoscopy). There were no adverse events related to PCC endoscopy. Limitations: A retrospective study and a selected patient population. Data may not be applicable to other settings. Conclusion: In this retrospective case series of patients with incomplete colonoscopy, PCC endoscopy did not always satisfactorily examine the colon