Melmed Gil Y, Dubinsky Marla C, Rubin David T, Fleisher Mark, Pasha Shabana F, Sakuraba Atsushi, Tiongco Felix, Shafran Ira, Fernandez-Urien Ignacio, Rosa Bruno, Papageorgiou Neofytos P, Leighton Jonathan A
F Widjaja Inflammatory Bowel and Immunobiology Research Institute, Cedars Sinai Medical Center, Los Angeles, California, USA.
Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Mount Sinai Hospital, New York, New York, USA.
Gastrointest Endosc. 2018 Dec;88(6):947-955.e2. doi: 10.1016/j.gie.2018.07.035. Epub 2018 Aug 4.
This prospective, multicenter study evaluated small-bowel capsule endoscopy (CE) for the longitudinal assessment of mucosal inflammation in subjects with Crohn's disease (CD).
Subjects with known CD underwent clinical evaluation with ileocolonoscopy and CE at baseline and 6-month follow-up. Small-bowel patency was confirmed before CE at both time points. The Simple Endoscopic Score for CD (SES-CD) was used for ileocolonoscopy, and the Lewis score and the CE CD Endoscopic Index of Severity (CECDEIS) were used for CE. Clinical scoring indices included the Physician Global Assessment (PGA), CD Activity Index (CDAI), and Harvey-Bradshaw Index (HBI). Laboratory markers including C-reactive protein, fecal calprotectin, and erythrocyte sedimentation rate were collected at baseline and follow-up. Correlation between endoscopic scores and clinical parameters were measured using Spearman tests.
A total of 74 subjects were enrolled, of whom 53 (72%) completed endoscopic procedures at baseline and 6-month follow-up. The SES-CD ileocolonoscopy score correlated with the Lewis score (P < .001, ρ = .59) and CECDEIS capsule score (P = .002, ρ = .48). None of the 3 endoscopic scores correlated with PGA, CDAI, HBI, C-reactive protein, erythrocyte sedimentation rate, or fecal calprotectin. Approximately 85% of subjects had proximal small-bowel inflammation identified on CE. There were no CE-related adverse events.
There was high correlation between CE and ileocolonoscopy scores for the assessment of mucosal disease activity over time; however, there were no correlations between endoscopic scores and clinical parameters. The use of serial CE for the assessment of small-bowel CD is feasible and valid. (Clinical trial registration number: NCT01942720.).
这项前瞻性多中心研究评估了小肠胶囊内镜（CE）对克罗恩病（CD）患者黏膜炎症的纵向评估作用。
已知患有CD的受试者在基线期和6个月随访时接受了回结肠镜检查和CE的临床评估。在两个时间点进行CE前均确认了小肠通畅性。回结肠镜检查采用CD的简单内镜评分（SES-CD），CE采用Lewis评分和CE CD内镜严重程度指数（CECDEIS）。临床评分指标包括医生整体评估（PGA）、CD活动指数（CDAI）和哈维-布拉德肖指数（HBI）。在基线期和随访时收集包括C反应蛋白、粪便钙卫蛋白和红细胞沉降率在内的实验室指标。使用Spearman检验测量内镜评分与临床参数之间的相关性。
共纳入74名受试者，其中53名（72%）在基线期和6个月随访时完成了内镜检查。SES-CD回结肠镜检查评分与Lewis评分（P <.001，ρ =.59）和CECDEIS胶囊评分（P =.002，ρ =.48）相关。3种内镜评分均与PGA、CDAI、HBI、C反应蛋白、红细胞沉降率或粪便钙卫蛋白无关。约85%的受试者在CE检查中发现近端小肠炎症。未发生与CE相关的不良事件。
在评估黏膜疾病活动随时间的变化方面，CE与回结肠镜检查评分之间具有高度相关性；然而，内镜评分与临床参数之间无相关性。连续使用CE评估小肠CD是可行且有效的。（临床试验注册号：NCT01942720。）
