Digestive Diseases and Sciences

, Volume 62, Issue 1, pp 180–187 | Cite as

Diagnostic Value of Small Bowel Capsule Endoscopy in Isolated Ileitis: A CAPENTRY Study

  • Hyun Seok Lee
  • Yun Jeong LimEmail author
  • Ki Nam Shim
  • Chang Mo Moon
  • Hyun Joo Song
  • Jin Oh Kim
  • Seong Ran Jeon
  • Dae Young Jung
  • Ji Hyun Kim
  • Kyeong Ok Kim
  • Bo-In Lee
  • The Korean Gut Image Study Group
Original Article



Capsule endoscopy (CE) has proven to be highly effective at detecting small bowel lesions, but studies regarding the diagnostic impact of CE on ileitis are rare.


We evaluated the diagnostic value of small bowel CE for isolated ileitis observed during ileocolonoscopy.


The CE results in 137 patients initially diagnosed with ileitis without colonic mucosal abnormalities on ileocolonoscopy at one of eight tertiary referral centers between October 2002 and June 2015 were retrospectively analyzed.


Among the 137 patients with isolated ileitis observed on ileocolonoscopy, 117 (85.4%) revealed positive small bowel CE findings (85.4%). The rate of positive small bowel CE findings was 92.9% in cases of ileal aphthous ulcer or erosion, and 90.9% in cases of ileal ulcer. Among 117 positive CE cases, the most common final diagnosis by CE was Crohn’s disease (CD) (n = 44, 32%). No findings were identified in 20 (14.6%) of 137 cases. Ileal erosion/ulcer, rather than findings such as nodularity and erythema or elevated erythrocyte sedimentation rate (ESR) (>10 mm/h), was significant predictive factors for positive CE findings in multivariate analysis.


Small bowel CE showed a high diagnostic yield (85.4%) in symptomatic patients with isolated ileitis on ileocolonoscopy. Erosion or ulcer of the small bowel was a common finding on CE (66.4%), and approximately one-third of patients were diagnosed with CD. In patients with isolated ileitis on ileocolonoscopy, CE should be considered to evaluate small bowel lesions when the patient shows an elevated ESR or when the ileitis manifests as ileal ulcer or erosion rather than a nodular or erythematous lesion.


Ileitis Capsule endoscopy Colonoscopy Ileoscopy 



No financial relationships with a commercial entity producing healthcare-related products and/or services relevant to this article are declared.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Bojica D, Markovicb S. Terminal ileitis is not always Crohn’s disease. Ann Gastroenterol. 2011;24:271–275.Google Scholar
  2. 2.
    Chang HS, Lee D, Kim JC, et al. Isolated terminal ileal ulcerations in asymptomatic individuals: natural course and clinical significance. Gastrointest Endosc. 2010;72:1226–1232.CrossRefPubMedGoogle Scholar
  3. 3.
    Jeong SH, Lee KJ, Kim YB, et al. Diagnostic value of terminal ileum intubation during colonoscopy. J Gastroenterol Hepatol. 2008;23:51–55.CrossRefPubMedGoogle Scholar
  4. 4.
    Kedia S, Kurrey L, Pratap Mouli V, et al. Frequency, natural course and clinical significance of symptomatic terminal ileitis. J Dig Dis. 2016;17:36–43.CrossRefPubMedGoogle Scholar
  5. 5.
    Dilauro S, Crum-Cianflone NF. Ileitis: when it is not Crohn’s disease. Curr Gastroenterol Rep. 2010;12:249–258.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Lee HS, Lim YJ. Capsule endoscopy for ileitis with potential involvement of other sections of the small bowel. Gastroenterol Res Pract. 2016;2016:9804783.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Rex DK, Petrini JL, Baron TH, et al. Quality indicators for colonoscopy. Am J Gastroenterol. 2006;101:873–885.PubMedGoogle Scholar
  8. 8.
    Jensen MD, Nathan T, Kjeldsen J. Inter-observer agreement for detection of small bowel Crohn’s disease with capsule endoscopy. Scand J Gastroenterol. 2010;45:878–884.CrossRefPubMedGoogle Scholar
  9. 9.
    Mehdizadeh S, Chen GC, Barkodar L, et al. Capsule endoscopy in patients with Crohn’s disease: diagnostic yield and safety. Gastrointest Endosc. 2010;71:121–127.CrossRefPubMedGoogle Scholar
  10. 10.
    Van Assche G, Dignass A, Panes J, et al. The second European evidence-based consensus on the diagnosis and management of Crohn’s disease: definitions and diagnosis. J Crohns Colitis. 2010;4:7–27.CrossRefPubMedGoogle Scholar
  11. 11.
    Gal E, Geller A, Fraser G, et al. Assessment and validation of the new capsule endoscopy Crohn’s disease activity index (CECDAI). Dig Dis Sci. 2008;53:1933–1937.CrossRefPubMedGoogle Scholar
  12. 12.
    Ersoy O, Harmanci O, Aydinli M, et al. Capability of capsule endoscopy in detecting small bowel ulcers. Dig Dis Sci. 2009;54:136–141.CrossRefPubMedGoogle Scholar
  13. 13.
    Triester SL, Leighton JA, Leontiadis GI, et al. A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with non-stricturing small bowel Crohn’s disease. Am J Gastroenterol. 2006;101:954–964.CrossRefPubMedGoogle Scholar
  14. 14.
    Shim KN, Kim YS, Kim KJ, et al. Abdominal pain accompanied by weight loss may increase the diagnostic yield of capsule endoscopy: a Korean multicenter study. Scand J Gastroenterol. 2006;41:983–988.CrossRefPubMedGoogle Scholar
  15. 15.
    Song HJ, Shim KN. Current status and future perspectives of capsule endoscopy. Intest Res. 2016;14:21–29.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Courville EL, Siegel CA, Vay T, et al. Isolated asymptomatic ileitis does not progress to overt Crohn disease on long-term follow-up despite features of chronicity in ileal biopsies. Am J Surg Pathol. 2009;33:1341–1347.CrossRefPubMedGoogle Scholar
  17. 17.
    Sachar DB, Luppescu NE, Bodian C, et al. Erythrocyte sedimentation as a measure of Crohn’s disease activity: opposite trends in ileitis versus colitis. J Clin Gastroenterol. 1990;12:643–646.CrossRefPubMedGoogle Scholar
  18. 18.
    Sachar DB, Smith H, Chan S, et al. Erythrocytic sedimentation rate as a measure of clinical activity in inflammatory bowel disease. J Clin Gastroenterol. 1986;8:647–650.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Hyun Seok Lee
    • 1
  • Yun Jeong Lim
    • 2
    Email author
  • Ki Nam Shim
    • 3
  • Chang Mo Moon
    • 3
  • Hyun Joo Song
    • 4
  • Jin Oh Kim
    • 5
  • Seong Ran Jeon
    • 5
  • Dae Young Jung
    • 6
  • Ji Hyun Kim
    • 7
  • Kyeong Ok Kim
    • 8
  • Bo-In Lee
    • 6
  • The Korean Gut Image Study Group
  1. 1.Department of Internal Medicine, Kyungpook National University Medical CenterKyungpook National University School of MedicineDaeguKorea
  2. 2.Department of Internal Medicine, Dongguk University Ilsan HospitalDongguk University College of MedicineGoyangKorea
  3. 3.Department of Internal MedicineEwha Womans University School of MedicineSeoulKorea
  4. 4.Department of Internal MedicineJeju National University College of MedicineJejuKorea
  5. 5.Department of Internal MedicineSoonchunhyang University College of MedicineSeoulKorea
  6. 6.Department of Internal Medicine, College of MedicineThe Catholic University of KoreaSeoulKorea
  7. 7.Department of Internal MedicineInje University College of MedicineBusanKorea
  8. 8.Department of Internal MedicineYeungnam University College of MedicineDaeguKorea

Personalised recommendations