Small bowel capsule endoscopy in the management of established Crohn's disease

Clinical impact, safety, and correlation with inflammatory biomarkers

Uri Kopylov, Artur Nemeth, Anastasios Koulaouzidis, Richard Makins, Gary Wild, Waqqas Afif, Alain Bitton, Gabriele Wurm Johansson, Talat Bessissow, Rami Eliakim, E. Tóth, Ernest G. Seidman

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

Background: Multiple studies have established the superior diagnostic accuracy of video capsule endoscopy (VCE) for the diagnosis of small bowel (SB) Crohn's disease (CD). However, data on the clinical impact of VCE in patients with established CD are scarce. The aim of this study was to examine the impact and safety of VCE on the clinical management of patients with established CD. Methods: A retrospective, multicenter, cross-sectional study. The study cohort included consecutive patients with established SB CD who underwent VCE in 4 tertiary referral centers (1 Canada, 1 Sweden, and 2 United Kingdom) from January 2008 to October 2013. Patients were excluded if VCE was performed as a part of the initial diagnostic workup. The presence of SB mucosal inflammation was quantified using the Lewis score. Inflammatory biomarkers (C-reactive protein and fecal calprotectin) were measured and correlated with the Lewis score. Results: The study included 187 patients. No SB inflammation was observed in 28.4%, mild-to-moderate inflammation in 26.6%, and moderate-tosevere inflammation in 45% of the patients (median Lewis score, 662; range, 0-6400). A change in management was recommended in 52.3% of the patients based on VCE findings. Elevated C-reactive protein, fecal calprotectin, or the combination of both were poorly correlated with significant SB inflammation. SB capsule retention occurred in 4 patients (2.1%). Conclusions: VCE in patients with established CD is safe, and the results often have a significant clinical impact. VCE should not be limited to CD patients with positive inflammatory markers because their predictive value for significant SB inflammation is poor.

Original languageEnglish
Pages (from-to)93-100
Number of pages8
JournalInflammatory Bowel Diseases
Volume21
Issue number1
DOIs
Publication statusPublished - Jan 1 2015

Fingerprint

Capsule Endoscopy
Crohn Disease
Biomarkers
Safety
Inflammation
Leukocyte L1 Antigen Complex
C-Reactive Protein
Sweden
Tertiary Care Centers
Canada
Capsules
Cohort Studies
Cross-Sectional Studies

Keywords

  • Capsule endoscopy
  • Crohn's disease
  • Fecal calprotectin
  • Patency capsule

ASJC Scopus subject areas

  • Gastroenterology
  • Immunology and Allergy
  • Medicine(all)

Cite this

Small bowel capsule endoscopy in the management of established Crohn's disease : Clinical impact, safety, and correlation with inflammatory biomarkers. / Kopylov, Uri; Nemeth, Artur; Koulaouzidis, Anastasios; Makins, Richard; Wild, Gary; Afif, Waqqas; Bitton, Alain; Johansson, Gabriele Wurm; Bessissow, Talat; Eliakim, Rami; Tóth, E.; Seidman, Ernest G.

In: Inflammatory Bowel Diseases, Vol. 21, No. 1, 01.01.2015, p. 93-100.

Research output: Contribution to journalArticle

Kopylov, U, Nemeth, A, Koulaouzidis, A, Makins, R, Wild, G, Afif, W, Bitton, A, Johansson, GW, Bessissow, T, Eliakim, R, Tóth, E & Seidman, EG 2015, 'Small bowel capsule endoscopy in the management of established Crohn's disease: Clinical impact, safety, and correlation with inflammatory biomarkers', Inflammatory Bowel Diseases, vol. 21, no. 1, pp. 93-100. https://doi.org/10.1097/MIB.0000000000000255
Kopylov, Uri ; Nemeth, Artur ; Koulaouzidis, Anastasios ; Makins, Richard ; Wild, Gary ; Afif, Waqqas ; Bitton, Alain ; Johansson, Gabriele Wurm ; Bessissow, Talat ; Eliakim, Rami ; Tóth, E. ; Seidman, Ernest G. / Small bowel capsule endoscopy in the management of established Crohn's disease : Clinical impact, safety, and correlation with inflammatory biomarkers. In: Inflammatory Bowel Diseases. 2015 ; Vol. 21, No. 1. pp. 93-100.
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abstract = "Background: Multiple studies have established the superior diagnostic accuracy of video capsule endoscopy (VCE) for the diagnosis of small bowel (SB) Crohn's disease (CD). However, data on the clinical impact of VCE in patients with established CD are scarce. The aim of this study was to examine the impact and safety of VCE on the clinical management of patients with established CD. Methods: A retrospective, multicenter, cross-sectional study. The study cohort included consecutive patients with established SB CD who underwent VCE in 4 tertiary referral centers (1 Canada, 1 Sweden, and 2 United Kingdom) from January 2008 to October 2013. Patients were excluded if VCE was performed as a part of the initial diagnostic workup. The presence of SB mucosal inflammation was quantified using the Lewis score. Inflammatory biomarkers (C-reactive protein and fecal calprotectin) were measured and correlated with the Lewis score. Results: The study included 187 patients. No SB inflammation was observed in 28.4{\%}, mild-to-moderate inflammation in 26.6{\%}, and moderate-tosevere inflammation in 45{\%} of the patients (median Lewis score, 662; range, 0-6400). A change in management was recommended in 52.3{\%} of the patients based on VCE findings. Elevated C-reactive protein, fecal calprotectin, or the combination of both were poorly correlated with significant SB inflammation. SB capsule retention occurred in 4 patients (2.1{\%}). Conclusions: VCE in patients with established CD is safe, and the results often have a significant clinical impact. VCE should not be limited to CD patients with positive inflammatory markers because their predictive value for significant SB inflammation is poor.",
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AU - Makins, Richard

AU - Wild, Gary

AU - Afif, Waqqas

AU - Bitton, Alain

AU - Johansson, Gabriele Wurm

AU - Bessissow, Talat

AU - Eliakim, Rami

AU - Tóth, E.

AU - Seidman, Ernest G.

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N2 - Background: Multiple studies have established the superior diagnostic accuracy of video capsule endoscopy (VCE) for the diagnosis of small bowel (SB) Crohn's disease (CD). However, data on the clinical impact of VCE in patients with established CD are scarce. The aim of this study was to examine the impact and safety of VCE on the clinical management of patients with established CD. Methods: A retrospective, multicenter, cross-sectional study. The study cohort included consecutive patients with established SB CD who underwent VCE in 4 tertiary referral centers (1 Canada, 1 Sweden, and 2 United Kingdom) from January 2008 to October 2013. Patients were excluded if VCE was performed as a part of the initial diagnostic workup. The presence of SB mucosal inflammation was quantified using the Lewis score. Inflammatory biomarkers (C-reactive protein and fecal calprotectin) were measured and correlated with the Lewis score. Results: The study included 187 patients. No SB inflammation was observed in 28.4%, mild-to-moderate inflammation in 26.6%, and moderate-tosevere inflammation in 45% of the patients (median Lewis score, 662; range, 0-6400). A change in management was recommended in 52.3% of the patients based on VCE findings. Elevated C-reactive protein, fecal calprotectin, or the combination of both were poorly correlated with significant SB inflammation. SB capsule retention occurred in 4 patients (2.1%). Conclusions: VCE in patients with established CD is safe, and the results often have a significant clinical impact. VCE should not be limited to CD patients with positive inflammatory markers because their predictive value for significant SB inflammation is poor.

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