IntroductionFaecal calprotectin (FC) is a well-established marker of gut inflammation. While the correlation of elevated FC levels with colonic inflammation has been confirmed in several studies,1,2 data regarding the correlation of FC with small-bowel inflammation is either scarce or conflicting.3 Capsule endoscopy (CE) is the modality of choice for detection of small-bowel inflammation and/or small-bowel Crohn’s disease (CD).4 Therefore, we aimed to systematically review and meta-analyse the evidence for the diagnostic accuracy of FC as a predictor of small-bowel CD.MethodsA comprehensive literature search of the databases PubMed and Embase was performed, using the search string: “capsule endoscopy” + calprotectin. Studies including patients with suspected and/or established CD evaluated by both FC and CE were retrieved. Corresponding authors were contacted for any missing data. The following FC cut-offs were evaluated: >50, 100 and 200 μg/g, as available in each included study. A diagnostic meta-analysis was performed; pooled diagnostic sensitivity (Se), specificity (Sp) and diagnostic odds ratio (DOR) with 95% confidence intervals (95% CI) were obtained for each of the cut-offs. Bias was evaluated using the quality assessment of studies of diagnostic accuracy in systematic reviews (QUADAS) 2 tool. A minimum of 4 studies was required for each analysis.ResultsA total of 135 studies were identified; seven (3 prospective, 4 retrospective) studies, including 463 patients, entered the final analysis. Overall, the methodological quality of the studies was high, with 6/7 studies showing low risk of bias. For studies including only patients with suspected CD, the diagnostic accuracy of FC for the cut-off of 50 μg/g was as follows: 5 studies, 305 patients; Se 89% (CI 68%;97%), Sp 55% (CI 36%;73%), DOR 10.3 (CI 3.7;28.6) . For all included studies (suspected and established CD), the DOR was significant for all the evaluated FC cut-offs. FC > 50μg/g: 7 studies, 463 patients; Se 83% (CI 73%;90%), Sp 53% (CI 36%;71%), DOR 5.64 (CI 3.2;10.1). FC > 100μg/g: 5 studies, 379 patients; Se 68% (CI 56%;76%), Sp 71% (CI 46%;88%), DOR 5.01 (CI 2.03;12.07). FC > 200μg/g: 4 studies, 309 patients; Se 42% (CI 26%;64%), Sp 94% (CI 64%;99%), DOR 13.64 (CI 2.01;88.6). Sensitivity analysis based on methodological quality did not change those results significantly.ConclusionThis meta-analysis confirms that FC, when used as a predictor of small-bowel CD prior to CE, has high diagnostic accuracy. For patients with suspected CD, a FC cut-off level of 50 μg/g provided high sensitivity and DOR, while for the entire patient cohort (suspected and established CD) FC > 200 μg/g provided the best overall DOR. The likelihood of diagnosing small-bowel CD is extremely low in suspected CD patients with FC < 50μg/g.References1 D’Haens G, et al. Faecal calprotectin is a surrogate marker for endoscopic lesions in inflammatory bowel disease. Inflamm Bowel Dis 2012;18:2218–2224.2 Van Rheenen PF, et al. Faecal calprotectin for screening of patients with suspecte...
IntroductionCollagenous colitis (CC) is a syndrome of chronic, watery, non-bloody diarrhoea.1 Its worldwide incidence is increasing; emerging evidence suggests a possible association between CC and malignancy.2 However, studies thus far have been inconclusive and data on the incidence of metachronous extra-colonic malignancy (MEcM) in CC is scarce.3 This study aimed to determine the occurrence of MEcM in patients with CC.MethodsRetrospective study; data on MEcM in patients previously diagnosed with CC was collected within NHS Lothian (Scotland) over a 14 year period (Jan 2000 – Nov 2013). Person-years at risk were calculated according to age-specific categories. The standard error (Se) was calculated using the Poisson approximation. Relative risk (RR) and confidence interval (CI) of the age-standardised rate (ASR) were compared to publicly available population data for Lothian, Scotland.4 Results are reported as average ± standard deviation or RR with confidence interval (CI). P values <0.05 were considered statistically significant.ResultsIn the aforementioned period, 394 patients were diagnosed with CC and included for analysis. Thirty-three (21 F/12 M) developed MEcM, Table 1. The average age of the group with MEcM was 71.6 ±7.4 years compared to 65.9 ±13.6 years for the remainder of the patients (P < 0.05). The average duration of follow-up from CC diagnosis to MEcM was 2 ±2.23 years and for the group as a whole was 4 ±3.45 years. The RR for lung cancer (4.63, 1.30;16.49) and total cancers (2.34, 1.38;3.95) in patients with CC was higher compared to population data from Lothian (P < 0.05 for both).Abstract PTU-053 Table 1ConclusionThe RR of MEcM, including lung cancer, is higher in patients with CC.The increased RR for lung cancer may be explained by the association between CC and smoking.5Further collective data will be useful to clarify other associations.References1 Münch A, et al. Microscopic colitis: current status, present and future challenges: statements of the European Microscopic Colitis Group. J Crohn’s Colitis 2012;6:932–945.2 Freeman HJ. Complications of collagenous colitis. World J gastroenterol 2008;14:1643.3 Chan JL, et al. Cancer risk in collagenous colitis. Inflamm Bowel Dis 1999;5:40–43.4 5 Vigren L, et al. Is smoking a risk factor for collagenous colitis? Scand J Gastroenterol 2011;46:1334–1339.Disclosure of InterestNone Declared
IntroductionBlue mode (BM) is one of the features of proprietary software (RAPID®; Medtronic Ltd) for capsule endoscopy (CE) review. BM is a colour coefficient shift of light in the short wavelength range (490–430 nm) superimposed onto a white light (WL) image.1 Recently, studies have shown that BM improves visualisation of vascular and erythematous non-vascular CE lesions.1,2 We aimed to objectively evaluate the validity of BM in CE in assessing the surface annotations of angiectasias as compared to WL.MethodsA set of 100 anonymised images of angiectasias was used, with the lesions captured both in WL and BM in the same pose. The entire dataset is available in our online database, KID (). Three reviewers (2 experts and one novice in CE review) graphically annotated the lesions using Ratsnake annotation tool (). The images were reviewed in WL and BM twice to estimate the inter- and intra-observer variability (at least 7 days apart). The Jaccard index (JI) was used to assess the similarity (agreement) of the annotations performed by the reviewers.ResultsUnder WL, the average inter-observer agreement ranged between 65±15% (novice vs. expert reviewer) and 67±13% (between experts), while the intra-observer agreement, ranged between 69±17% and 71±13%. Under BM, the average inter-observer agreement ranged between 56±19% (novice vs. expert reviewer) and 78±18% (between experts). The average intra-observer agreement in BM ranged between 69±20% and 73±8.ConclusionBM CE image review does not improve significantly the surface annotations of angiectasias -as compared to WL- for expert or novice reviewers.3,4 References1 Abdelaal UM, et al. Blue mode imaging may improve the detection and visualisation of small-bowel lesions: A capsule endoscopy study. Saudi J Gastroentero 2015;21:418–22.2 Krystallis C, et al. Chromoendoscopy in small bowel capsule endoscopy: Blue mode or Fuji Intelligent Colour Enhancement? Dig Liver Dis 2011;43:953–7.3 Koulaouzidis A, et al. Blue mode does not offer any benefit over white light when calculating Lewis score in small-bowel capsule endoscopy. World J Gastrointest Endosc 2012;4:33–7.4 Koulaouzidis A, et al. QuickView in small-bowelcapsule endoscopy is useful in certain clinical settings, but QuickView with BlueMode is of no additional benefit. Eur J Gastroenterol Hepatol 2012;24:1099–104.Disclosure of InterestNone Declared
IntroductionDouble balloon enteroscopy (DBE) is a relatively invasive and lengthy procedure necessitating careful consideration of patients’ comorbidities. We aim to assess the safety of DBE in patients with cardiovascular disease (CVD).MethodsBetween June 2006 and January 2016, 568 consecutive patients undergoing DBE were reviewed across 3 teaching hospitals in the UK and Italy. Demographic and clinical data were collected and patients were categorised by age (elderly: ≥70 years and young: <70 years) and the presence or absence of CVD. Comparisons were made of diagnostic and therapeutic yields and complications rates.ResultsCVD was present in 185 patients (mean age 70±9.7, 51% male) who underwent DBE for iron deficiency anaemia (54%) overt gastrointestinal bleeding (25%), suspected Crohn’s disease (10%), small bowel strictures (6%) and suspected coeliac disease complications (4%). CVD (elderly vs young) included ischaemic heart disease (59% vs 68%, p = 0.2), valve replacement (23% vs 16%, p = 0.3), atrial fibrillation (31% vs 11%, p < 0.05) and congestive cardiac failure (21% vs 8.5%, p < 0.05). The 2 groups (elderly vs young) had similar propofol requirements (1320 mg vs 999 mg, p = 0.5), but midazolam (4 mg vs 5.5 mg, p < 0.05) and fentanyl (36.5 mcg vs 75 mcg, p < 0.05) use was less in the elderly. The most common abnormalities (elderly vs young) were ulcers (5.5% vs 10%, p = 0.4), strictures (3% vs 3%, p = 1.0), tumours (2% vs 7%, p = 0.2) and angioectasias (43% vs 27%, p < 0.05). Diagnostic yield (67% vs 64%, p = 0.8) and complication rates (5.5% vs 2%, p = 0.3) were comparable. However, therapeutic yield was higher in the elderly (50.5% vs 33%, p < 0.05).All CVD patients were compared to 383 patients without CVD (mean age 50±14.1, 44% male). Diagnostic yield was higher in those with CVD compared to those without (65% vs 50%, p < 0.05), as was therapeutic yield (42% vs 17%, p < 0.05). Irrespective of age, angioectasias were commoner in patients with CVD compared to those without (34.6% vs. 8.4%, p < 0.05). The difference seen in complications between both groups was not significant (2.7% vs 0.8%, p = 0.12). Complications seen in the CVD group included 2 cases of systemic infections, 2 cases of respiratory compromise and 1 case of myocardial infarction.ConclusionWe report the first multicentre study attesting the safety of patients with CVD undergoing DBE. Moreover, patients with CVD have higher diagnostic and therapeutic yield at DBE and thus with careful selection, these patients are most likely to benefit from the procedure.Disclosure of InterestNone Declared
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