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Medicineworld.org: Capsule Endoscopy Diagnoses More Crohn's Disease

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Capsule Endoscopy Diagnoses More Crohn's Disease




Research from La Fe University Hospital in Valencia, Spain shows that capsule endoscopy diagnoses more Crohn's disease recurrence after surgery than colonoscopy. Capsule endoscopy led to changes in treatment for more than half of the patients studied. The research appears in the recent issue of Gastrointestinal Endoscopy, the monthly peer-evaluated scientific journal of the American Society for Gastrointestinal Endoscopy.



Capsule Endoscopy Diagnoses More Crohn's Disease
Image courtesy of Yale Medical Group

Crohn's disease is a chronic condition that causes inflammation in the gastrointestinal tract, most usually affecting the small intestine and colon (large intestine). As per the Crohn's and Colitis Foundation of America, approximately half a million people in the United States have Crohn's disease. Scientists do not know what causes the disease and there is no cure, so the goal of therapy is to reduce the inflammatory response. Surgery becomes necessary when medicine can no longer control symptoms. In most cases, the diseased segment of the intestines is removed, this is called a resection. The two sections of the remaining healthy intestines are joined together in a procedure called anastomosis. While patients may live symptom-free for years, surgery is not a cure and disease frequently recurs at or near the site of the anastomosis.

Colonoscopy is the gold standard in screening for colorectal cancer, which develops in the large intestine. It is effective in diagnosing diseases of the large intestine and in viewing the end part of the small intestine. Capsule endoscopy allows physicians to view the entire small intestine, but is not currently a method used to view the large intestine.

"Crohn's disease occurs in both the small and large intestines. In this study we observed that in comparison to colonoscopy, capsule endoscopy was able to identify Crohn's disease recurrence in 62 percent of patients, whereas colonoscopy only identified inflammatory lesions in 25 percent of patients," said the study's lead author Vicente Pons Beltrán, MD, PhD, La Fe University Hospital. "We believe this is due to capsule endoscopy's ability to visualize the entire small intestine, including parts of the upper small intestine that colonoscopy is not designed to reach".

Capsule endoscopy allows physicians to examine the lining of the middle part of the gastrointestinal tract, which includes the three portions of the small intestine (duodenum, jejunum, ileum). A tiny camera is contained inside of a pill that the patient swallows. It captures images of the gastrointestinal tract as it travels through the body and transmits the images to a computer so the doctor can view them and make a diagnosis.

Patients and Methods.

Recurrence after surgery to treat Crohn's disease is frequent and unpredictable. The efficacy of post-surgery capsule endoscopy in detecting recurrence in patients with Crohn's disease is yet to be confirmed. The objective of this study was to assess the safety, accuracy, and therapeutic impact of capsule endoscopy. Twenty-four Crohn's disease patients from La Fe University Hospital in Valencia, Spain who had ileocolonic resection, followed by reconnection of the ileum to the colon, were subjects in the study.

All patients were asymptomatic and not on any medical treatment for Crohn's disease. Colonoscopy and capsule endoscopy were used to visualize and assess Crohn's disease at the anastomosis and in the remaining small intestine. Capsule endoscopy waccording toformed within two weeks of colonoscopy. Investigators were blinded to the results of each technique. Patient comfort during the procedures was also recorded.

Results.

A colonoscopy waccording toformed in all patients, eventhough the end part of the small intestine could not be reached in three of them. Two of the patients had a narrowing in the small intestine, which precluded capsule endoscopy from being performed.

Recurrent Crohn's disease was visualized in the remaining end of the small intestine with colonoscopy in six patients; capsule endoscopy identified five of these six patients plus another ten patients with disease recurrence higher up in the small intestine. A decision to modify treatment was made in 13 patients. Colonoscopy alone would have led to this decision in six patients; capsule endoscopy alone provided data in the remaining seven patients.

All patients preferred capsule endoscopy, an expected finding in this study where only one third of the patients undergoing colonoscopy received sedation. Scientists concluded that capsule endoscopy is of great use in the evaluation and therapy of recurrent Crohn's disease. While colonoscopy remains the gold standard for evaluation of the colon and tissue acquisition, the capsule provides an invaluable window into the sizable small bowel inaccessible by colonoscopy. The two methods are complimentary in diagnosing and treating diseases of the gastrointestinal tract.


Posted by: Sue    Source




Did you know?
Research from La Fe University Hospital in Valencia, Spain shows that capsule endoscopy diagnoses more Crohn's disease recurrence after surgery than colonoscopy. Capsule endoscopy led to changes in treatment for more than half of the patients studied. The research appears in the recent issue of Gastrointestinal Endoscopy, the monthly peer-evaluated scientific journal of the American Society for Gastrointestinal Endoscopy.

Medicineworld.org: Capsule Endoscopy Diagnoses More Crohn's Disease

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