Impact of proximal small bowel lesions detected by capsule endoscopy in Crohn's Disease patients

Aims Capsule endoscopy (CE) is an increasingly used method for the evaluation and monitoring of small bowel Crohn’s Disease (CD). Our study aimed to describe the clinical significance of small bowel CD, specifically, proximal lesions diagnosed using CE.

Methods Retrospective study including patients with inflammatory bowel disease (CD, ulcerative colitis [UC] and unclassified colitis) who underwent capsule endoscopy to assess the small bowel. Small bowel disease was evaluated by the Lewis score and the Capsule Endoscopy Crohn’s Disease Activity Index (CECDAI) score. Clinical impact was evaluated through treatment modifications.

Results We included 70 patients, 44 (62.9%) with established CD, 12 (17.1%) with UC and 14 (20.0%) with unclassified colitis. Median age at diagnosis was 28.5 years (interquartile range [IQR], 20.75-38.50) and 42 (60.0%) patients were women. Regarding patients with CD, at diagnosis, 20 (45.5%) patients had terminal ileal lesions (L1 according to Montreal Classification), 10 (22.7%) ileocolonic disease (L3), 8 (18.2%) colonic disease (L2), 4 (9.1%) both ileal and upper disease (L1+L4) and 2 (4.5%) patients had only upper disease (L4). Most of the cases (38, 86.4%) had inflammatory phenotype. After performing CE, a new extension was determined in 19 (43.2%) patients; in 10 (52.6%) cases who were initially classified as terminal ileum disease (L1), CE also detected upper lesions (L4). Of the 14 patients with unclassified colitis, 5 (35.7%) were finally diagnosed with CD according to CE findings. Three (25.0%) of the patients with UC were newly diagnosed as CD due to the CE results. CE was able to identify proximal disease in 30 (42.9%) patients, 28 (93.3%) had CD. Median Lewis score was 1220 (IQR, 450-1956) and median CECDAI was 12 (IQR, 7-16). In respect of management, 35 patients (33 of these had CD) required treatment modifications, 82.9% of them were due to the findings on CE, (62.1% of these adjustments were attributable to CE proximal lesions). Treatment changes mainly involved adding steroids (34.5%), azathioprine (41.4%), adalimumab (24.1%) or infliximab (13.7%).

Conclusions CE allows detection and characterization of proximal lesions in CD with a high diagnostic field. These findings have a considerable impact on treatment decisions.

Conflicts of interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
15 April 2024