117 Diagnostic Yield of Capsule Endoscopy Versus Magnetic Resonance Enterography and Small Bowel Contrast Ultrasound for Evaluation of Small Bowel Crohn's Disease; a Systematic Review and Meta-Analysis

Kopylov, Uri; Yung, Diana E; Engel, Tal; Vijayan, Sanju; Har-Noy, Ofir; Katz, Lior H.; Avni, Tomer; Eliakim, Abraham R.; Ben‐Horin, Shomron; Koulaouzidis, Anastasios

doi:10.1016/j.gie.2017.03.051

Cited by 9 publications

(20 citation statements)

References 23 publications

(34 reference statements)

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“…MRE examinations have a tendency to miss the diagnosis of CD in the jejunum. 26 In our study, VCE showed significant inflammatory activity in the jejunum in more than 25% of all examinations, indicating the importance of VCE in the Therapeutic Advances in Gastroenterology 11 6 journals.sagepub.com/home/tag workup of patients with CD. It should be emphasized that jejunal CD lesions were detected in more than half of the patients with established CD in our study.…”

Section: Discussionsupporting

confidence: 52%

Video capsule endoscopy in pediatric patients with Crohn’s disease: a single-center experience of 180 procedures

Németh

Agardh

Johansson

et al. 2018

Therap Adv Gastroenterol

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BackgroundVideo capsule endoscopy (VCE) is a noninvasive method enabling excellent visualization of the small bowel (SB) mucosa. The aim of this study was to examine the impact and safety of VCE performed in children and adolescents with suspected or established Crohn’s disease (CD).MethodsA total of 180 VCE examinations in 169 consecutive patients conducted in 2003–14 in a single center were retrospectively analyzed. The median age was 13 years (range 3–17 years) and indications for VCE were suspected (125 cases, 69%) and established (55 cases, 31%) CD. VCE was performed with a PillCam SB (Given Imaging, Yokneam, Israel) VCE system with 8–12 h of registration without bowel preparation.ResultsA total of 154 of 180 (86%) patients swallowed the capsule and 26 (14%) had the capsule endoscopically placed in the duodenum. Patency capsule examination was performed in 71 cases prior to VCE to exclude SB obstruction. VCE detected findings consistent with SB CD in 71 (40%) examinations and 17 (9%) procedures showed minor changes not diagnostic for CD. A total of 92 (51%) examinations displayed normal SB mucosa. The capsule did not reach the colon within the recording time in 30 (17%) procedures and were defined as incomplete examinations. A change in diagnosis or therapy was recommended in 56 (31%) patients based on VCE results. Capsule retention occurred in one patient.ConclusionsVCE is a safe method in children with suspected or established CD. VCE often leads to a definitive diagnosis and has a significant impact on the clinical management of pediatric patients with CD.

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Section: Discussionsupporting

confidence: 52%

Video capsule endoscopy in pediatric patients with Crohn’s disease: a single-center experience of 180 procedures

Németh

Agardh

Johansson

et al. 2018

Therap Adv Gastroenterol

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“…The main indications of CE in established CD include disease classification, monitoring for mucosal healing, and evaluation of unexplained symptoms and anemia. [1][2][3][4][5] In the recent European Crohn's and Colitis Organisation [ECCO] and the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] guidelines, CE is recommended along with intestinal ultrasound and magnetic resonance enterography for initial evaluation and follow-up of established CD. 2 In a recent study, quantitative assessment of small bowel inflammation on CE was the most accurate predictor of relapse within two years in CD patients in remission.…”

Section: Introductionmentioning

confidence: 99%

A novel PillCam Crohn’s capsule score (Eliakim score) for quantification of mucosal inflammation in Crohn’s disease

Eliakim

Yablecovitch²,

Lahat³

et al. 2020

UEG Journal

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Introduction Capsule endoscopy is an important modality for monitoring of Crohn’s disease. Recently, a novel panenteric capsule, PillCam Crohn’s (Medtronic, USA), was approved for use. No quantitative index of inflammation for this method is currently available. This sub-study of a prospective randomized controlled Comprehensive individUalized pRoactive ThErapy of Crohn’s Disease trial (CURE-CD) which aimed to compare the correlation and reliability of the novel PillCam Crohn’s score with the existing small bowel capsule Lewis inflammatory score. Methods The study cohort included Crohn’s disease patients in remission who were evaluated with PillCam Crohn’s. Each result was independently reviewed by two experienced readers. Inflammation was scored in all studies using Lewis inflammatory score and PillCam Crohn’s score (comprised of a sum of scores for most common and most severe lesions multiplied by percentage of segmental involvement + stricture score). Results Fifty-four PillCam Crohn’s studies from 41 patients were included. The median Lewis inflammatory score was 225 for both readers. The median PillCam Crohn’s score was six (0–14) and four (3–15) for readers 1 and 2, respectively. There was a high inter-rater reliability coefficient between the two readers for Lewis inflammatory and PillCam Crohn’s score (0.9, p < 0.0001 for both). The correlation between PillCam Crohn’s score and fecal calprotectin was stronger than for Lewis inflammatory score ( r = 0.32 and 0.54 respectively, p = 0.001 for both). Conclusions The novel panenteric capsule score correlates well with the Lewis inflammatory score, has excellent reliability, and may be potentially more accurate in estimation of the panenteric inflammatory burden.

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“…For diagnosis of Crohn's disease (CD), the diagnostic yield of CE is higher than that of ileocolonoscopy and CT enterography, and overall similar to that of magnetic resonance enterography (MRE), 1 though recent studies have shown its superiority over MRE in the proximal small bowel. [2][3][4] CE is more sensitive than other modalities for detection of proximal small disease and subtle mucosal inflammation, 2,3,5,6 and is more acceptable to patients in comparison to MRE. 7 CE can detect active mucosal inflammation in at least 50% of patients with small-bowel CD in clinical remission.…”

Section: Introductionmentioning

confidence: 99%

The Lewis score or the capsule endoscopy Crohn’s disease activity index: which one is better for the assessment of small bowel inflammation in established Crohn’s disease?

Yablecovitch

Lahat

Neuman

et al. 2018

Therap Adv Gastroenterol

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BackgroundSmall-bowel capsule endoscopy (CE) is a prime modality for evaluation of the small bowel. The Lewis score (LS) and the Capsule Endoscopy Crohn’s Disease Activity Index (CECDAI) are validated endoscopic indices for quantification of small-bowel inflammation on CE. It is unclear whether these indexes are interchangeable for the evaluation of mucosal inflammation in established Crohn’s disease (CD). The aim of this study was to compare the quantitative evaluation of small- bowel inflammation by LS and CECDAI.MethodsPatients with known quiescent small-bowel CD for at least 3 months (Crohn’s disease activity index < 150) were prospectively recruited and underwent CE. The LS was calculated using RAPID 8 capsule-reading software and the CECDAI was calculated manually. Cumulative LS (C-LS) was calculated by summation of individual tertile LS. Fecal calprotectin (FCP) and C-reactive protein (CRP) levels were measured and correlated with the scores.ResultsA total of 50 patients were included in the study. There was a moderate correlation between the worst segment LS and CECDAI (Pearson’s r = 0.66, p = 0.001), and a strong correlation between C-LS and CECDAI (r = 0.81, p = 0.0001). CECDAI < 5.4 corresponded to mucosal healing (LS < 135), while CECDAI > 9.2 corresponded to moderate-to-severe inflammation (LS ⩾ 790). There was a moderate correlation between capsule scores and FCP levels (r = 0.39, p = 0.002 for LS, r = 0.48, p = 0.001 for C-LS, and r = 0.53, p = 0.001 for CECDAI, respectively). CRP levels were not significantly correlated with either score.ConclusionsCECDAI and C-LS are strongly correlated and perform similarly for quantitative assessment of mucosal inflammation in established CD.

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117 Diagnostic Yield of Capsule Endoscopy Versus Magnetic Resonance Enterography and Small Bowel Contrast Ultrasound for Evaluation of Small Bowel Crohn's Disease; a Systematic Review and Meta-Analysis

Cited by 9 publications

References 23 publications

Video capsule endoscopy in pediatric patients with Crohn’s disease: a single-center experience of 180 procedures

Video capsule endoscopy in pediatric patients with Crohn’s disease: a single-center experience of 180 procedures

A novel PillCam Crohn’s capsule score (Eliakim score) for quantification of mucosal inflammation in Crohn’s disease

The Lewis score or the capsule endoscopy Crohn’s disease activity index: which one is better for the assessment of small bowel inflammation in established Crohn’s disease?

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