Evaluation of postsurgical recurrence in Crohn's disease:: a new indication for capsule endoscopy?

Background: Recurrence after surgery to treat Crohn's disease is frequent and unpredictable. The efficacy of postsurgety capsule endoscopy in detecting recurrence in patients with Crohn's disease is yet to be confirmed. Objective: To assess the safety, accuracy, and therapeutic impact of capsule endoscopy in these patients. Design: Crohn's disease recurrence at the neoileum (Rutgeers score) was assessed in the patients by colonoscopy and capsule endoscopy. The M2A Patency Capsule (Given Imaging, Yoqneam, Israel) was administered 1 week before capsule endoscopy. Capsule endoscopy was performed within 2 weeks of colonoscopy. Investigators were blinded to the results of each technique. Patient comfort during the procedures was recorded. Patients: Twenty-four patients with Crohn's disease with ileocolonic anastomosis were prospectively included. All patients were asymptornatic and did not receive any prophylactic treatment. Main Outcome Measurements: Neoileum recurrence. Results: A colonoscopy was performed in all patients, although the neoileum could not be reached in 3 of them. M2A Patency Capsule excretion was delayed in 2 patients; thus capsule endoscopy was given only to 22 patients. Recurrence was visualized with colonoscopy in 6 patients and with capsule endoscopy in 5. Ten additional recurrences were visualized only with capsule endoscopy. Moreover, proximal involvement was detected in 13 patients. Therapeutic management was modified in 16 patients. All patients preferred capsule endoscopy. Conclusions: Capsule endoscopy is more effective in the evaluation of recurrence after surgery for Crohn's disease and is better tolerated than colonoscopy. This is of significant therapeutic relevance.