Video capsule endoscopy in inflammatory bowel disease 2005

Purpose of review Crohn's disease remains a clinical diagnosis based on a typical clinical history, physical examination, small bowel radiography, and ileocolonoscopy with biopsy. Wireless video capsule endoscopy allows direct visualization of the entire small bowel mucosa. This review analyzes recently reported studies assessing diagnostic yield, impact on management, and outcomes associated with this new procedure. Safety issues, particularly capsule retention, are also reviewed. Recent findings A number of recently published studies report 'diagnostic yields' for Crohn's disease from capsule endoscopy of over 70% in patients with negative, or inconclusive, findings on prior small bowel series and ileocolonoscopy. Capsule endoscopy is a more sensitive examination than traditional radiography, but the specificity and positive predictive values remain to be established. Most series report a positive influence on patient outcome based on capsule findings, but the specific details of management changes and specific outcomes are often not adequately described. Furthermore, 'mucosal breaks' are seen in 14% of normal volunteers, even in the absence of recent nonsteroidal antiinflammatory drugs. Capsule retention occurs in less than 1% of patients with suspected Crohn's, but retention rates of 4-6% are reported in patients with established Crohn's. Summary Capsule endoscopy is an effective tool in the diagnosis and follow-up of patients with Crohn's disease. Prospective comparative studies with adequate control groups and predefined clinical endpoints are necessary to determine the true role of this technology in Crohn's disease.