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Número 3 - EII al día

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Debatenoscopia sigue siendo, a fecha de hoy, el gold standarden la EICI; sin embargo, la buena tolerancia de la CE frentea la colonoscopia puede hacerle ganar terreno en estesentido, sobre todo si se v<strong>al</strong>idan índices que permitanun diagnóstico preciso de EC mediante la CE. Por estehecho es una técnica que se incluye ya en la v<strong>al</strong>oraciónde pacientes con sospecha clínica de EC tras demostrarla ausencia de lesiones mediante endoscopia <strong>al</strong>ta y bajacon ileoscopia (29-30) .Su superioridad parece indiscutible en aquellos pacientesen los que se precise v<strong>al</strong>orar extensión o recurrenciade la enfermedad y, aunque son necesarios más estudiosque consoliden esta indicación, en un futuro próximoprobablemente se acepte la obligatoriedad de re<strong>al</strong>izarun estudio con CE a todos los pacientes con sospecha deEC, o <strong>al</strong> menos a aquellos en los que se vaya a tomar unaactitud terapéutica agresiva.Por otro lado, su capacidad para detectar EC en pacientesetiquetados de CI debe llevarnos a evitar el término deenfermedad inflamatoria intestin<strong>al</strong> de tipo indeterminadomientras no se haya re<strong>al</strong>izado previamente un estudiocon CE.En el futuro, la necesidad de más estudios no va a sertanto por demostrar la superioridad de la CE en v<strong>al</strong>orarla extensión de la enfermedad, que se presume elevada,sino más bien en orientar sus objetivos a determinarsi esta información tendrá o no impacto en la actitudterapéutica a seguir.BIBLIOGRAFÍA1. Fireman Z, Mahajna E, Broide E, Shapiro M, Fich L, Sternberg A, KopelmanY, Scapa E. Diagnosing sm<strong>al</strong>l bowel Crohn’s disease with wirelesscapsule endoscopy. Gut. 2003 Mar;52(3):390-2.2. Viazis N, Karamanolis DG. Indeterminate colitis—the role of wirelesscapsule endoscopy. Aliment Pharmacol Ther. 2007 Jan 1;25(1):13-7.3. Herrerías JM, Caunedo A, Rodríguez-Téllez M, Pellicer F, Herrerías JM Jr.Capsule endoscopy in patients with suspected Crohn’s disease and negativeendoscopy. Endoscopy. 2003 Jul;35(7):564-8.4. V<strong>al</strong>le J, Alcántara M, Pérez-Grueso MJ, Navajas J, Muñoz-Rosas C, LegazML, Cuena R, Carrobles JM. Clinic<strong>al</strong> features of patients with negativeresults from tradition<strong>al</strong> diagnostic work-up and Crohn’s disease findingsfrom capsule endoscopy. J Clin Gastroenterol. 2006 Sep;40(8):692-6.5. Ge ZZ, Hu YB, Xiao SD. Capsule endoscopy in diagnosis of sm<strong>al</strong>l bowelCrohn’s disease. 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Sm<strong>al</strong>l bowel mucos<strong>al</strong> injury is reduced in he<strong>al</strong>thy subjects treatedwith celecoxib compared with ibuprofen plus omeprazole, as assessed byvideo capsule endoscopy. Aliment Pharmacol Ther. 2007 May15;25(10):1211-22.13. Dubcenco E, Jeejeebhoy KN, Petroniene R, Tang SJ, Z<strong>al</strong>ev AH, GardinerGW, Baker JP. Capsule endoscopy findings in patients with establishedand suspected sm<strong>al</strong>l-bowel Crohn’s disease: correlation with radiologic,endoscopic, and histologic findings. Gastrointest Endosc. 2005Oct;62(4):538-44.14. G<strong>al</strong> E, Geller A, Fraser G, Levi Z, Niv Y. Assessment and V<strong>al</strong>idation of theNew Capsule Endoscopy Crohn’s Disease Activity Index (CECDAI). Dig DisSci. 2007 Nov 22; [Epub ahead of print]15. Gr<strong>al</strong>nek IM, Defranchis R, Seidman E, Leighton JA, Legnani P, Lewis BS.Development of a capsule endoscopy scoring index for sm<strong>al</strong>l bowel mucos<strong>al</strong>inflammatory change. Aliment Pharmacol Ther. 2008 Jan15;27(2):146-54. Epub 2007 Oct 23.16. Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, BrantSR, Caprilli R, Colombel JF, Gasche C, Geboes K, Jewell DP, KarbanA, Loftus Jr EV, Peña AS, Riddell RH, Sachar DB, Schreiber S, SteinhartAH, Targan SR, Vermeire S, Warren BF. Toward an integrated clinic<strong>al</strong>,molecular and serologic<strong>al</strong> classification of inflammatory boweldisease: Report of a Working Party of the 2005 Montre<strong>al</strong> World Congressof Gastroenterology. Can J Gastroenterol. 2005; 19 Suppl A: 5-36.17. Pons Beltrán V, Nos P, Bastida G, Beltrán B, Argüello L, Aguas M, RubínA, Pertejo V, S<strong>al</strong>a T. Ev<strong>al</strong>uation of postsurgic<strong>al</strong> recurrence in Crohn’s disease:a new indication for capsule endoscopy? Gastrointest Endosc 2007;66: 533-540.18. Bourreille A, Jarry M, D’H<strong>al</strong>luin PN, Ben-Soussan E, Maunoury V, Bulois P,Sacher-Huvelin S, Vahedy K, Lerebours E, Heresbach D, Bretagne JF, ColombelJF, G<strong>al</strong>miche JP. Wireless capsule endoscopy versus ileocolonoscopyfor the diagnosis of postoperative recurrence of Crohn’s disease: aprospective study. Gut 2006; 55: 978-83.19. Eliakim R, Suissa A, Yassin K, Katz D, Fischer D. Wireless capsule video endoscopycompared to barium follow-through and computerised tomographyin patients with suspected Crohn’s disease—fin<strong>al</strong> report. Dig LiverDis. 2004 Aug;36(8):519-22.173 • Enfermedad Inflamatoria Intestin<strong>al</strong> <strong>al</strong> día - Vol. 7 - Nº. 2 - 2008

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