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  • Capsule endoscopy visualizes recurrences of Crohn’s disease

Oct 2007
Capsule endoscopy has been shown to be more effective than colonoscopy in diagnosing the recurrence of Crohn’s disease after surgery. At La Fe University Hospital in Valencia, Spain, investigators conducted a study on 24 patients with Crohn’s disease who had undergone resection, the removal of the diseased section of the intestine, and anastomosis, the joining together of the remaining healthy section.

They found that capsule endoscopy can identify disease recurrence in 62 percent of patients, whereas colonoscopy identified evidence of the disease in only 25 percent. The main objective of the study was to evaluate capsule endoscopy in terms of safety, accuracy and therapeutic effect. The research is detailed in the September issue of Gastrointestinal Endoscopy.

Because there is no known cause or cure for Crohn’s disease, the treatment goal is to reduce the inflammation. When medication no longer controls the symptoms, surgery is performed, but recurrence frequently follows it.

Capsule endoscopy allows physicians to view the lining of the middle section of the gastrointestinal (GI) tract, including the three portions of the small intestine — the duodenum, jejunum and ileum — but the method is not used to view the large intestine. A patient swallows a pill that contains a tiny camera, which captures images of the GI tract and transmits them to a computer for diagnostic viewing.

Colonoscopy, the standard tool used in screening for colon cancer, effectively diagnoses diseases in the large intestine; however, although it enables the closer sections of the small intestine to be viewed, it is not designed to reach the most distant portions.

All 24 subjects underwent a colonoscopy, and 22 of them, capsule endoscopy using the M2A Capsule System from Given Imaging Ltd. of Yokneam, Israel, to assess the disease at the site of the anastomosis and in the remaining small intestine. Colonoscopy did not reach the end part of the small intestine in three of the patients. All subjects were asymptomatic and were not receiving treatment for the disease.

Colonoscopy detected recurring disease in the remaining end of the small intestine in six patients. Capsule endoscopy identified five of these six patients and another 10 patients with recurrence higher up in the small intestine. These findings resulted in the decision to modify therapy in 13 patients. Colonoscopy alone would have led to altered treatment in six patients, while capsule endoscopy alone provided data in the seven remaining patients.

The researchers concluded that capsule endoscopy is an important tool for visualizing the small intestine, which is inaccessible by colonoscopy, and that both methods are complementary in the diagnosis and treatment of diseases in the gastrointestinal tract. Also, patients noted during the study that they were more comfortable with the capsule endoscopy method.

A light-tight box that receives light from an object or scene and focuses it to form an image on a light-sensitive material or a detector. The camera generally contains a lens of variable aperture and a shutter of variable speed to precisely control the exposure. In an electronic imaging system, the camera does not use chemical means to store the image, but takes advantage of the sensitivity of various detectors to different bands of the electromagnetic spectrum. These sensors are transducers...
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