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Crohn's Disease Diagnosed By Video Capsule Endoscopy: Presented at ACG
By Maggie Schwarz
BALTIMORE, MD -- October 15, 2003 -- Video capsule endoscopy was used to image the bowel of a pregnant woman, avoiding medication and irradiation, as reported here.
Kim Isaacs, MD, PhD, and Lisa Gangarosa, MD, of the University of North Carolina, Chapel Hill, North Carolina, United States, presented a novel use of this technology at the 68th Annual Scientific Meeting of the American College of Gastroenterology.
They discussed the case of a 22-year-old pregnant woman who presented with symptoms suggesting either irritable bowel syndrome or inflammatory bowel disease. A differential diagnosis was needed to start appropriate therapy.
Video capsule endoscopy was undertaken because it has been reported to be fairly sensitive in detecting small bowel mucosal lesions in Crohn's disease. Moreover, it does not require the use of medications or ionising radiation, as do the more invasive strategies of endoscopy and x-rays.
The patient swallowed the capsule and wore a belt so that she could carry the recording device for 8 hours. The wireless capsule takes 50,000 images during transit time. It has LED crystals that afford a light source. The recording device consists of eight aerials carried in the belt.
The images showed distal small bowel abnormalities starting at 2 hours and at 48 minutes into the recording. Initially small aphthous ulcerations were noted. These became more severe with deep linear ulcerations and submucosal haemorrhage from 2 hours and 49 minutes to 3 hours and 35 minutes into the recording. The cecum was reached at 3 hours and 36 minutes into the recording.
The main risk of video capsule endoscopy is capsule retention, which has been described in 0.75% of procedures. In cases of capsule obstruction, surgery is necessary to remove it, which in this patient would have been detrimental to the pregnancy. If the capsule is retained but does not cause obstruction, it can be removed at the end of the pregnancy.
Capsule endoscopy should not be used in a patient who presents with obstructive symptoms, the researchers said. In such patients, other imaging techniques, such as magnetic resonance imaging, should be considered.
Dr. Isaacs noted that the onset of Crohn's disease is most common between the ages of 15 and 25 years, when women are in their early childbearing years. Video capsule endoscopy is a potentially safe and sensitive means of diagnosing Crohn's disease in the pregnant patient, she added.
[Study title: Crohn's Disease During Pregnancy With Small Bowel Capsule Endoscopy. Abstract 76]
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