Omori Teppei, Koroku Miki, Murasugi Shun, Ito Ayumi, Yonezawa Maria, Tokushige Katsutoshi
Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Suginami Hospital, Tokyo, Japan.
Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
Inflamm Intest Dis. 2024 Mar 28;9(1):115-124. doi: 10.1159/000538468. eCollection 2024 Jan-Dec.
Small bowel (SB) capsule endoscopy (SBCE) is a sensitive modality for screening the entire SB of patients with Crohn's disease (CD); however, the prognostic impact of the results is unclear. We evaluated the ability of the SBCE score to predict therapeutic intervention for patients with CD and SB lesions without clinical symptoms as well as negative C-reactive protein (CRP) levels.
Fifty-six patients who underwent a patency evaluation and had a CD activity index (CDAI) score <150 mg/dL and CRP level <0.5 mg/dL were included. Twenty-one and 35 patients had CD classified as Montreal classifications L1 and L3, respectively. The initial SBCE scores were subsequently grouped according to the presence or absence of intervention based on cutoff values. We examined whether the scores could predict the need for therapeutic intervention at 1 year, 2 years, and 5 years. The CD activity in capsule endoscopy (CDACE) score was used as the SBCE score.
The median observation period was 1,326 days. Twenty-one patients received therapeutic intervention. There were significant differences between patients with and without treatment intervention according to the CDACE cutoff value of 420 at 1 year, 2 years, and 5 years. Significant differences between patients with Montreal classification L1 with and without intervention were observed at 1 year and 2 years. The CDACE score was moderately and strongly correlated with the Lewis score and capsule endoscopy CDAI score, respectively (Spearman rank correlation coefficient: = 0.6462 and = 0.9199, respectively; < 0.0001).
A CDACE score ≥420 is predictive of intervention after 1 year for patients with CD, a CDAI score <150, and a CRP level <0.5 mg/dL. A larger study with a prospective design is necessary to validate our findings.
小肠（SB）胶囊内镜检查（SBCE）是筛查克罗恩病（CD）患者整个小肠的一种敏感方法；然而，其结果对预后的影响尚不清楚。我们评估了SBCE评分预测CD合并无临床症状及C反应蛋白（CRP）水平阴性的SB病变患者进行治疗干预的能力。
纳入56例接受了通畅性评估且CD活动指数（CDAI）评分<150 mg/dL和CRP水平<0.5 mg/dL的患者。分别有21例和35例患者的CD根据蒙特利尔分类法被分类为L1和L3。随后根据基于临界值的干预情况将初始SBCE评分进行分组。我们研究了这些评分是否能够预测1年、2年和5年后进行治疗干预的必要性。胶囊内镜检查中的CD活动（CDACE）评分用作SBCE评分。
中位观察期为1326天。21例患者接受了治疗干预。根据1年、2年和5年时420的CDACE临界值，接受治疗干预和未接受治疗干预的患者之间存在显著差异。在1年和2年时，观察到蒙特利尔分类L1的患者接受干预和未接受干预之间存在显著差异。CDACE评分分别与Lewis评分和胶囊内镜CDAI评分呈中度和强相关性（斯皮尔曼等级相关系数：分别为 = 0.6462和 = 0.9199； < 0.0001）。
对于CDAI评分<150且CRP水平<0.5 mg/dL的CD患者，CDACE评分≥420可预测1年后的干预情况。需要进行一项更大规模的前瞻性设计研究来验证我们的发现。
