Practice Guidelines and Consensus on Capsule Endoscopy

ASGE Position on Capsule Endoscopy Capsule endoscopy (CE) is a less invasive technique for evaluating the small intestine for Crohn’s involvement Shown to be more sensitive than radiologic and endoscopic procedures for detecting small bowel lesions Leighton JA et al. Gastrointest Endosc. 2006;63(4):

American College of Gastroenterology In prospective, blinded evaluations, CE was demonstrated to be superior in its ability to detect small bowel pathology missed on small bowel radiologic studies and computed tomography (CT) radiologic examinations Small bowel strictures are considered a contraindication for CE Capsule retention reported to occur in up to 13% of patients with known long-term Crohn’s disease Patency capsules are available to assess the potential of retention resulting from a stricture Small bowel follow-through, CT enterography, or magnetic resonance (MR) enterography recommended before CE Lichtenstein GR et al. Am J Gastroenterol. 2009:104(2):

European Society of Gastrointestinal Endoscopy Valuable tool in the diagnosis of small bowel diseases, especially bleeding lesions and CD High yield in finding small bowel lesions in CD Permits confirmation of diagnosis of small bowel CD when the diagnosis was not possible by other conventional means Detected more proximal and middle small bowel cases of CD than did CT enterography and SBFT Limitations: false-positive/-negative results (image angle accuracy), no tissue sampling, inter-observer variability, risk of retention Rey JF et al. Endoscopy. 2006;38(10):

OMED-ECCO Consensus in the Management of Patients with IBD Small bowel CE (SBCE) should be reserved for cases in which ileocolonoscopy plus small bowel radiography is not diagnostic, but the suspicion of Crohn’s disease remains high SBCE may be better than small bowel follow-through or enteroclysis at identifying small bowel mucosal lesions consistent with Crohn’s disease SBCE may be superior to MR enterography for detection of mucosal lesions consistent with Crohn’s disease SBCE may be superior to CTE or CT enteroclysis for detection of mucosal lesions consistent with Crohn’s disease Bourreille et al. Endoscopy 2009;41:

International Conference on Capsule Endoscopy ™ (ICCE ™ ) Consensus for Crohn’s Disease CE may play an important role in the evaluation of some patients with known or suspected CD 1 More sensitive for assessing small bowel mucosal lesions in adult and pediatric patients than any other imaging technique 1,2 Shown to be superior to ileoscopy, push enteroscopy, small bowel radiography (SBFT and enteroclysis), CT enterography, and small-bowel MR imaging Negative CE findings in pediatric patients could likely exclude CD, whereas other imaging techniques tend to yield higher numbers of false-positive results 1. Kornbluth A et al. Endoscopy. 2005;37(10): Mergener K et al. Endoscopy. 2007;39(10):

International Conference on Capsule Endoscopy (ICCE) Consensus for Crohn’s Disease (continued) Can be a useful adjunctive test (e.g., with colonoscopy with ileoscopy) to discriminate between CD and UC in patients with IC 1,2 Can identify small bowel lesions better than other imaging methods; more sensitive than serological markers CE can lead to changes in therapy based on the extent and/or severity of the inflammation found in the small bowel 1 1. Mergener K et al. Endoscopy. 2007;39(10): Kornbluth A et al. Endoscopy. 2005;37(10):

International Conference on Capsule Endoscopy (ICCE) Conclusions CE can identify small bowel mucosal lesions not seen with other imaging modalities and may, therefore, play an important role in the evaluation of patients with known or suspected CD For known CD, CE may be useful in the evaluation of unexplained symptoms May also prove to be of value in the evaluation of IC May have a unique role in assessing mucosal healing after medical therapy and for assessing early post- operative recurrence and for guiding therapy May serve as a subclinical marker in asymptomatic family members and may contribute to the understanding of the natural history of IBD Kornbluth A et al. Endoscopy. 2005;37(10):

Practice Guidelines Key Points CE is a less invasive technique for evaluating the small intestine for Crohn’s involvement In prospective, blinded evaluations, CE was demonstrated to be superior in its ability to detect small bowel pathology missed on small bowel radiologic studies and CT radiologic examinations Small bowel CE (SBCE) should be reserved for cases in which ileocolonoscopy plus small bowel radiography is not diagnostic, but the suspicion of Crohn’s disease remains high CE can lead to changes in therapy based on the extent and/or severity of the inflammation found in the small bowel