Elevated fecal calprotectin: Does capsule endoscopy have a role in the diagnostic algorithm?

The purpose of this study was to examine the utility of small bowel capsule endoscopy (SBCE) in the diagnostic pathway of patients that had elevated fecal calprotectin (FC) and normal colonoscopy.

Patients with elevated FC and normal colonoscopy that underwent SBCE in the last 4 years were included. Patients were divided into 3 groups: group 1: patients with isolated small bowel Crohn's disease (SBCD) on SBCE; group 2: patients with elevated FC but normal SBCE; and group 3: patients with isolated terminal ileitis.

The study included 320 patients (group 1: 254 patients, group 2: 50 patients, and group 3: 16 patients). The median age was 42.5 years (IQR 26) across the three groups and 52.4% of the patients had a new diagnosis of SBCD. In group 1, active disease was identified distally in 247 patients (77.2%), proximal involvement in 90 patients (28.1%), and extensive SBCD in 68 patients (21.3%). Magnetic resonance enterography (MRE) was carried out in 229 (90.1%) patients in group 1 and was negative in 42 patients with SBCD. The diagnostic yield of SBCE was higher than that of MRE (p < 0.0001). In group 2, the final diagnoses included Helicobacter pylori infection (n = 2), NSAID use (n = 3), celiac disease (n = 2), and microscopic colitis (n = 1). The final diagnoses in group 3 were idiopathic terminal ileitis (n = 11), inflammatory bowel disease (n = 3), and infective terminal ileitis (n = 2).

SBCE influences the patient pathway even when negative/normal. It is better at identifying early SBCD, when compared with MRE.