Wireless capsule endoscopy and Crohn’s disease

Wireless capsule endoscopy appears to be superior to all current forms of radiological investigation of the small intestine in detecting the mucosal abnormalities of Crohn’s disease When the wireless capsule endoscope (WCE) was introduced,1 fears that the capsule might become impacted caused early clinical protocols to exclude any patients with a hint of previous subacute obstruction or symptoms suggestive of Crohn’s disease.2–6 In fact a few patients with Crohn’s disease were inadvertently included in these early studies3–6 as the symptoms of this disease are often subtle and other investigations are sometimes inconclusive. WCE in a short time has acquired a well established role in the investigation of patients with recurrent gastrointestinal bleeding of obscure origin when gastroscopy and colonoscopy fail to reveal the source.2–6 Occult Crohn’s disease was found to be a cause of bleeding or anaemia in several of these series. Capsule endoscopy has been used in more than 100 000 patients worldwide. Several comparative studies have shown that WCE could outperform push enteroscopy in finding clinical causes of bleeding. Although the image quality of push enteroscopy is superior in the area it reached, WCE did not miss much that push enteroscopy saw and provided images from the large percentage of the small intestine that could not be reached by push enteroscopy. In five comparisons the capsule found more small intestinal pathology than push enteroscopy (66%, 68%, 69%, 55%, 66% v 19%, 32%, 36%, 38%, 28%)3–5,7,8 and four of these studies showed statistically significant differences in favour of capsule endoscopy.4,5,7,8 WCE has also performed well in comparisons with small bowel radiology. Just as the numbers of barium meal and barium enemas have atrophied with the widespread availability of gastroscopy and colonoscopy, radiological investigations of …