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Kopylov U, Klang E, Yablecovitch D, Lahat A, Avidan B, Neuman S, Levhar N, Greener T, Rozendorn N, Beytelman A, Yanai H, Dotan I, Chowers Y, Weiss B, Ben-Horin S, Amitai MM, Eliakim R. Magnetic resonance enterography versus capsule endoscopy activity indices for quantification of small bowel inflammation in Crohn's disease. Therap Adv Gastroenterol 2016; 9:655-63. [PMID: 27582877 PMCID: PMC4984327 DOI: 10.1177/1756283x16649143] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Video capsule endoscopy (VCE) and magnetic resonance enterography (MRE) are the prime modalities for the evaluation of small bowel (SB) Crohn's disease (CD). Mucosal inflammation on VCE is quantified using the Lewis score (LS). Diffusion-weighted (DW) magnetic resonance imaging (MRI) allows for accurate assessment of SB inflammation without administration of intravenous contrast material. The Magnetic Resonance Index of Activity (MaRiA) and the Clermont index are quantitative activity indices validated for contrast-enhanced MRE and DW-MRE, respectively. The aim of this study was to compare the quantification of distal SB inflammation by VCE and MR-related activity indices. METHODS Patients with known quiescent SB CD were prospectively recruited and underwent MRE and VCE. LS, MaRIA and Clermont scores were calculated for the distal SB. RESULTS Both MRI-based indices significantly correlated with the LS and the Clermont index (r = 0.50, p = 0.001 and r = 0.53, p = 0.001, respectively). Both MaRIA and Clermont scores were significantly lower in patients with mucosal healing (LS < 135). The area under the curve (AUC) with both MR scores was moderate for prediction of any mucosal inflammation (LS ⩾ 135) and excellent for prediction of moderate-to-severe inflammation (LS ⩾ 790) (0.71 and 0.74 versus 0.93 and 0.91 for MaRIA and Clermont score, respectively). CONCLUSIONS Modest correlation between VCE- and MRE-based quantitative indices of inflammation in patients with quiescent SB CD was observed. Between-modality correlation was higher in patients with endoscopically severe disease. DW-MRE gauged by Clermont score was at least as accurate as contrast-enhanced MRE for quantification of SB inflammation.
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Affiliation(s)
| | - Eyal Klang
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel,Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Doron Yablecovitch
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel,Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Adi Lahat
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel,Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Benjamin Avidan
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel,Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Sandra Neuman
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel,Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Nina Levhar
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel,Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Tomer Greener
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel,Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Noa Rozendorn
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel,Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Arkadi Beytelman
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel,Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Henit Yanai
- IBD Center, Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Iris Dotan
- IBD Center, Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Yehuda Chowers
- Rambam Health Care Campus, Haifa, Israel,Bruce Rappaport School of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Batya Weiss
- Edmond and Lily Safra Children’s Hospital, Tel Hashomer, Israel,Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Shomron Ben-Horin
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel,Sackler Faculty of Medicine, Tel Aviv University, Israel
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Collins PD. Video capsule endoscopy in inflammatory bowel disease. World J Gastrointest Endosc 2016; 8:477-488. [PMID: 27499830 PMCID: PMC4959941 DOI: 10.4253/wjge.v8.i14.477] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 05/01/2016] [Accepted: 06/03/2016] [Indexed: 02/06/2023] Open
Abstract
Video capsule endoscopy (VCE) has evolved to become an important tool for the non-invasive examination of the small bowel, which hitherto had been relatively inaccessible to direct visualisation. VCE has been shown to play a role in monitoring the activity of small bowel Crohn’s disease and can be used to assess the response to anti-inflammatory treatment in Crohn’s disease. For those patients with Crohn’s disease who have undergone an intestinal resection, VCE has been assessed as a tool to detect post-operative recurrence. VCE may also aid in the reclassification of patients with a diagnosis of Inflammatory Bowel Disease Unclassified to Crohn’s disease. The evolution of colon capsule endoscopy (CCE) has expanded the application of this technology further. The use of CCE to assess the activity of ulcerative colitis has been described. This advance in capsule technology has also fuelled interest in its potential role as a minimally invasive tool to assess the whole of GI tract opening the possibility of its use for the panenteric assessment of Crohn’s disease. VCE is a safe procedure. However, the risk of a retained capsule is higher in patients with suspected or confirmed Crohn’s disease compared with patients having VCE examination for other indications. A retained video capsule is rare after successful passage of a patency capsule which may be utilised to pre-screen patients undergoing VCE. This paper describes the use of VCE in the assessment of inflammatory bowel disease.
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Hall B, Holleran G, McNamara D. PillCam COLON 2 © as a pan-enteroscopic test in Crohn’s disease. World J Gastrointest Endosc 2015; 7:1230-1232. [PMID: 26566430 PMCID: PMC4639745 DOI: 10.4253/wjge.v7.i16.1230] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 09/08/2015] [Accepted: 09/30/2015] [Indexed: 02/05/2023] Open
Abstract
A recent paper by Boal Carvalho et al demonstrates the potential of PillCam COLON 2© (PCC2) as a pan-enteric investigation in Crohn’s disease (CD). Our own prospective data in patients with known CD also shows good correlation between PCC2 and small/large bowel investigations (R = 0.896, P < 0.0004/R = 0.6667, P < 0.035). Larger studies are warranted to prospectively validate the use of PCC2 in the investigation and monitoring of both small and large bowel CD.
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Rosa B, Pinho R, de Ferro SM, Almeida N, Cotter J, Saraiva MM. Endoscopic Scores for Evaluation of Crohn's Disease Activity at Small Bowel Capsule Endoscopy: General Principles and Current Applications. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2015; 23:36-41. [PMID: 28868428 PMCID: PMC5580095 DOI: 10.1016/j.jpge.2015.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 08/27/2015] [Indexed: 12/14/2022]
Abstract
The small bowel is affected in the vast majority of patients with Crohn's Disease (CD). Small bowel capsule endoscopy (SBCE) has a very high sensitivity for the detection of CD-related pathology, including early mucosal lesions and/or those located in the proximal segments of the small bowel, which is a major advantage when compared with other small bowel imaging modalities. The recent guidelines of European Society of Gastrointestinal Endoscopy (ESGE) and European Crohn's and Colitis Organisation (ECCO) advocate the use of validated endoscopic scoring indices for the classification of inflammatory activity in patients with CD undergoing SBCE, such as the Lewis Score or the Capsule Endoscopy Crohn's Disease Activity Index (CECDAI). These scores aim to standardize the description of lesions and capsule endoscopy reports, contributing to increase inter-observer agreement and enabling a stratification of the severity of the disease. On behalf of the Grupo de Estudos Português do Intestino Delgado (GEPID) - Portuguese Small Bowel Study Group, we aimed to summarize the general principles and clinical applications of current endoscopic scoring systems for SBCE in the setting of CD, covering the topic of suspected CD as well as the evaluation of disease extent (with potential prognostic and therapeutic impact), evaluation of mucosal healing in response to treatment and evaluation of post-surgical recurrence in patients with previously established diagnosis of CD.
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Affiliation(s)
- Bruno Rosa
- Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal
- Corresponding author.
| | - Rolando Pinho
- Gastroenterology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
- Gastroenterology Center, ManopH, Instituto CUF, Porto, Portugal
| | - Susana Mão de Ferro
- Gastroenterology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Nuno Almeida
- Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - José Cotter
- Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal
- Instituto de Investigação em Ciências da Vida e Saúde (ICVS), Escola de Ciências da Saúde, Universidade do Minho, Braga, Portugal
- Laboratório Associado ICVS/3B's, Braga, Portugal
| | - Miguel Mascarenhas Saraiva
- Gastroenterology Center, ManopH, Instituto CUF, Porto, Portugal
- ManopH – Laboratório de Endoscopia e Motilidade Digestiva, Porto, Portugal
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