Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastrointest Endosc. May 16, 2012; 4(5): 185-188
Published online May 16, 2012. doi: 10.4253/wjge.v4.i5.185
Does capsule endoscopy have an added value in patients with perianal disease and a negative work up for Crohn's disease?
Samuel N Adler, Metzger Yoav, Scapa Eitan, Chowers Yehuda, Rami Eliakim
Samuel N Adler, Metzger Yoav, Scapa Eitan, Chowers Yehuda, Rami Eliakim, Departments of Gastroenterology, Bikur Holim Hospital, Jerusalem, 91104 (ASN, MY), Asaf Harofeh, Zrifin 70300 (ES), and Rambam Health Care Campus, Haifa 31096 (CY, ER), Israel
Author contributions: Adler SN and Eliakim R were the primary investigators; all other authors contributed equally to the article.
Correspondence to: Rami Eliakim, Professor of Medicine, Head, Gastroenterology and Hepatology, Sheba Medical Center, Ramat-Gan 52506, Israel. abraham.eliakim@sheba.health.gov.il
Telephone: +972-3-5302679 Fax: +972-3-53059101
Received: November 8, 2011
Revised: February 22, 2012
Accepted: April 27, 2012
Published online: May 16, 2012
Abstract

AIM: To investigate the role of capsule endoscopy in patients with persistent perianal disease and negative conventional work up for Crohn’s disease (CD).

METHODS: Patients with perianal disease (abscesses, fistulas, recurrent fissures) were evaluated for underlying CD. Patients who had a negative work up, defined as a negative colonoscopy with a normal ileoscopy or a normal small bowel series or a normal CT/MR enterography, underwent a Pillcam study of the small bowel after signing informed consent. Patients using nonsteroidal anti-inflammatory drugs or who had a history of inflammatory bowel disease or rheumatic disease were excluded.

RESULTS: We recruited 26 patients aged 21-61 years (average 35.6 years), 17 males and 9 females. One case could not be evaluated since the capsule did not leave the stomach. In 6 of 25 (24%) patients with a negative standard work up for Crohn's disease, capsule endoscopy (CE) findings were consistent with Crohn's disease of the small bowel. Family history of CD, white blood cell, hemoglobin, erythrocyte sedimentation rate or C-reactive protein did not predict a diagnosis of CD. Capsule endoscopy findings led to a change in treatment.

CONCLUSION: In patients with perianal disease and a negative conventional work up to exclude CD, CE leads to incremental diagnostic yield of 24%.

Keywords: Perianal abscess; Perianal fistula; Ileo-colonoscopy; Capsule endoscopy; Crohn's disease