Impact of capsule endoscopy on management of inflammatory bowel disease: a single tertiary care center experience.

BACKGROUND: Capsule endoscopy (CE) is performed to assess inflammatory bowel disease (IBD). We aimed to define the results of CE in subtypes of IBD and to determine whether CE results in management changes.

METHODS: A retrospective cohort study was performed of all CEs for IBD at a tertiary care center from 2003-2009. Descriptive statistics were used to compare IBD-specific medications, surgeries, and imaging studies in the 3 months prior and 3 months after CE.

RESULTS: Of 907 CEs performed from 2003-2009, 128 were for an indication of symptomatic IBD and 124 capsules left the stomach (86 for Crohn's disease [CD], 15 for indeterminate colitis [IC], 23 for pouchitis). Only 22.1% of CEs done for CD were normal, as compared to 53.3% for IC and 34.8% for pouchitis. Severe findings in CD consisted of multiple aphthae/ulcers (22.1%), stenosis (8.1%), and stenosis with immediate retention (17.4%). In CD, 61.6% had a change in medication in the 3 months after the CE, with 39.5% initiating a new IBD medication, most commonly budesonide or corticosteroids. In the 3 months following CE, 12.8% of patients with CD underwent surgery. Severe findings on CE in patients with CD, as compared to no/minimal findings, resulted in significant differences in medication changes (73.2% versus 51.1%, P = 0.04), addition of medications (58.5% versus 22.2%, P < 0.01), and surgeries (21.9% versus 4.4%, P = 0.01).

CONCLUSIONS: CE results in management changes in the majority of cases of symptomatic IBD, regardless of the subtype of IBD.