Does capsule endoscopy have an added value in patients with perianal disease and a negative work up for Crohn's...

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

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.

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.

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