The role of small bowel capsule endoscopy and ileocolonoscopy in patients with nonspecific but suggestive symptoms of Crohn's disease

Ioannis V. Mitselos, Dimitrios K. Christodoulou*, Konstantinos H. Katsanos, Athina Tatsioni, Aleksandra Rapti, Rami Eliakim, Epameinondas V. Tsianos

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objectives Ileocolonoscopy (IC) and small bowel capsule endoscopy (SBCE) are essential tools in the investigation of suspected small bowel Crohn's disease (CD). Overutilization of SBCE should be avoided as it leads to unwanted healthcare expenses; thus, it is recommended when IC is normal and CD is still highly suspected. Our aim was to compare the role of SBCE and IC in the investigation of suspected CD irrespective of its location and assess the additional diagnostic benefit of SBCE over IC. Methods This was a retrospective study of 91 patients with chronic abdominal pain and/or diarrhea. All patients were evaluated with both colonoscopy (with terminal ileum intubation where possible) and SBCE. The severity of inflammation on SBCE was assessed using the Lewis Score. Endoscopic findings were analyzed toward CD diagnosis. Results The sensitivity of IC and SBCE in the diagnosis of either small bowel or colonic CD was 81.82 and 63.64%, whereas the specificity was 77.50 and 92.50%, respectively. Positive and negative predictive value was 33.33 and 96.88% for IC, as well as 53.85 and 94.87% for SBCE. Area under receiver operating characteristic curve was 0.797 for IC and 0.781 for SBCE. IC was superior to SBCE in diagnosing small and large bowel CD. SBCE showed the true extent of CD in one patient missed by IC. It identified lesions suggestive of CD in three patients with normal IC, one of whom was finally diagnosed with CD. Conclusion IC should be the initial diagnostic test in patients with nonspecific, but suggestive symptoms of CD. SBCE offers additional information on small bowel mucosa and disease extent.

Original languageEnglish
Pages (from-to)882-889
Number of pages8
JournalEuropean Journal of Gastroenterology and Hepatology
Issue number8
StatePublished - 1 Aug 2016


  • Crohn's disease
  • chronic abdominal pain
  • chronic diarrhea
  • colon capsule endoscopy
  • ileocolonoscopy
  • small bowel capsule endoscopy


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