The Diagnosis And Treatment Application Of Small Bowel Capsule Endoscopy In The Crohn’s Disease

Background and objectivesCrohn’s disease(Crohn diseases,CD)is a chronic inflammatory disease involving the whole digestive tract.About 80%of the patients involve the small intestine,and a third have small intestine as the only lesions.For a long time,an internal panorama of the small intestine cannot be observed intuitively,until the small bowel capsule endoscopy(SBCE)appears.SBCE is a new kind of endoscopy technology,and has become a cutting-edge technology in diagnosing small intestine diseases.However,the value of SBCE in the diagnosis and treatment of CD is still controversial.This research was conducted mainly from the following two aspects:1.Exploring the diagnosis value of SBCE for patients with suspected CD;2.Preliminarily analyzing the risk factors of unfinished examination and capsule retention when SBCE is performed on CD patients,and exploring the value of SBCE in evaluating the mucosal healing of CD patients.Methods1.The role of capsule endoscopy in the diagnosis of suspected Crohn’s disease This research summarized the clinical data of 435 patients with suspected Crohn’s disease who were examined by capsule endoscopy.Of these,23 cases also included the use of double balloon enteroscopy,while another 15 included small bowel computed tomography enterography.The diagnostic yield,accuracy rate,sensitivity and specificity of the three inspection methods were analyzed based on using the clinical symptoms,and results of radiological examination,digestive endoscopy,pathological examination,and follow-up observations as the basis of diagnosis.2.The role of capsule endoscopy in the diagnosis of diagnosed Crohn’s disease2.1 The proportion of unfinished examination and capsule retention rate of SBCE on the 302 CD patients were calculated,and the associated risk factors were analyzed by using logistic regression.2.2 The conditions of small intestinal and colonic mucosa healing before and after 30 weeks treatment were analyzed by observing the clinical effect of infliximab on the 36 small bowel CD patients.Result1.The application of capsule endoscopy in the diagnosis of suspected Crohn’s diseaseOf the 435 cases of suspected Crohn’s disease,267 patients were ultimately confirmed.The diagnostic yield,accuracy rate,sensitivity and specificity were 64.6%、89.4%、94.0%、82.1%for the small bowel capsule endoscopy,and 78.2%、91.3%、94.4%、80%for the double balloon enteroscopy,and 73.3%、86.7%、90.9%、75%for the computed tomography enterography,respectively.2.The application of capsule endoscopy in the diagnosis of diagnosed Crohn’s disease2.1 For the 302 cases of diagnosed CD patients,the uncompletion rate of the SBCE xamination was 33.44%,and the capsule retention rate was 5.6%.Using logistic regression,it was found that the reduction of albumin is a risk factor of the uncompletion of SBCE examination(OR = 3.040;P = 3.040),and that diarrhea the protection factor(OR = 0.434;P = 0.003).Also,elevated CRP was found to be a risk factor of capsule retention(OR = 3.967;P = 0.034).2.2 For the 36 patients who received IFX treatment for 30 weeks,the mucosal healing rate of colon and terminal ileum was 72.2%(26/36),and the mucosal healing rate of small intestinal was 30.6%(11/36).Also,11 patients whose small intestinal mucosa has healed were found to have colon and terminal ileum mucosal healing at the same time.Spearman correlation test results showed that there is moderate correlation between Lewis score and CRP(r = 0.564,P<0.001),low-grade correlation between Lewis score and CDAI(r = 0.435,P<0.001),and no correlation between Lewis score and SES-CD(r = 0.153,P = 0.117).ConclusionSmall bowel capsule endoscopy shows promising application value for suspected CD patients.The reduction of Albumin increases the risk of the incompletion of SBCE examination,but diarrhea can reduce the risk.Elevated c-reactive protein increases the risk of capsule retention.IFX can effectively help small intestine affected CD patients achieve clinical remission and mucosal healing.The mucosal healing in terminal ileum and other parts of small intestine are not synchronized for CD patients.The result of SBCE examination can be used as the basis of small intestinal mucosa healing.For CD patients whose small bowel and colon are both affected,it is recommended to combine SBCE and colonoscope for an entire gastrointestinal tract evaluation when treatment effect and mucosal healing are to be evaluated.