Monteiro S1, Dias de Castro F1, Boal Carvalho P1, Rosa B1, Moreira MJ1, Pinho R1, Saraiva MM1, Cotter J1.
1 Department of Gastroenterology, Hospital da Senhora da Oliveira-Guimarães, Rua dos Cutileiros, Creixomil, 4835-044 Guimarães, Portugal.
ABSTRACT
Aim
To evaluate the role of small bowel capsule endoscopy (SBCE) on the reclassification of colonic inflammatory bowel disease type unclassified (IBDU).
Methods
We performed a multicenter, retrospective study including patients with IBDU undergoing SBCE, between 2002 and 2014. SBCE studies were reviewed and the inflammatory activity was evaluated by determining the Lewis score (LS). Inflammatory activity was considered significant and consistent with Crohn's disease (CD) when the LS ≥ 135. The definitive diagnosis during follow-up (minimum 12 mo following SBCE) was based on the combination of clinical, analytical, imaging, endoscopic and histological elements.
Results
Thirty-six patients were included, 21 females (58%) with mean age at diagnosis of 33 ± 13 (15-64) years. The mean follow-up time after the SBCE was 52 ± 41 (12-156) mo. The SBCE revealed findings consistent with significant inflammatory activity in the small bowel (LS ≥ 135) in 9 patients (25%); in all of them the diagnosis of CD was confirmed during follow-up. In 27 patients (75%), the SBCE revealed no significant inflammatory activity (LS < 135); among these patients, the diagnosis of Ulcerative Colitis (UC) was established in 16 cases (59.3%), CD in 1 case (3.7%) and 10 patients (37%) maintained a diagnosis of IBDU during follow-up. A LS ≥ 135 at SBCE had a sensitivity = 90%, specificity = 100%, positive predictive value = 100% and negative predictive value = 94% for the diagnosis of CD.
Conclusion
SBCE proved to be fundamental in the reclassification of patients with IBDU. Absence of significant inflammatory activity in the small intestine allowed exclusion of CD in 94% of cases.
