Ukashi Offir, Lahat Adi, Ungar Bella, Veisman Ido, Levy Hadar, Sharif Kassem, Eidler Pinhas, Eliakim Rami, Kopylov Uri, Carter Dan, Ben-Horin Shomron, Albshesh Ahmad
Gastroenterology Institute, Sheba Medical Center Tel Hashomer, Ramat Gan, Israel.
Faculty of Medical and Health Sciences, Tel-Aviv University, Tel Aviv, Israel.
Inflamm Bowel Dis. 2024 Dec 19. doi: 10.1093/ibd/izae296.
Small bowel video capsule endoscopy (SB-VCE) assesses mucosal inflammation in Crohn's disease (CD), while intestinal ultrasound (IUS) examines transmural involvement. We aimed to correlate SB-VCE with IUS in evaluating active CD and monitoring treatment response over time.
Patients with active SB-CD who initiated biologics were prospectively followed with fecal calprotectin (FC), SB-VCE, and IUS at baseline and after 14 and 52 weeks. The Lewis score (LS), Limberg index (LI), and terminal ileum bowel wall thickness (TI-BWT) were documented, and the International Bowel Ultrasound Segmental Activity Score (IBUS-SAS) was retrospectively calculated. Biochemical, endoscopic, and ultrasonographic remission were defined as FC < 150 μg/g, LS < 135, and LI < 2 + TI-BWT ≤ 3 mm, respectively. A therapeutic response for each index was defined as a 25% reduction compared to baseline.
Seventy-one patients were included (median age: 30 years [23-43], 49.3% male). The median interval between SB-VCE and IUS was 3 days (0-25). Initially, the LS strongly correlated with TI-BWT (r = 0.647, P < .001), LI (r = 0.597, P < .001), and IBUS-SAS (r = 0.647, P < .001), but these correlations weakened over time (TI-BWT: r = 0.344, P = .002; LI: r = 0.471, P = .001; IBUS-SAS: r = 0.236, P = .122). Moderate agreement was found between ultrasonographic and endoscopic treatment responses (LS and TI-BWT: K = 0.51, P = .015; LS and LI: K = 0.44, P = .063), with fair agreement for remission (K = 0.27, P = .006). TI-BWT best cutoffs for mild (LS ≥ 135) and moderate-to-severe (LS ≥ 790) inflammation were 2.25 mm and 3.6 mm, respectively.
IUS measures are strongly correlated with VCE-inflammatory LS in active CD and may provide an assessment of endoscopic response and remission over time.
小肠视频胶囊内镜检查（SB-VCE）用于评估克罗恩病（CD）的黏膜炎症，而肠道超声检查（IUS）则用于检查透壁受累情况。我们旨在探讨SB-VCE与IUS在评估活动性CD及监测随时间变化的治疗反应方面的相关性。
对开始使用生物制剂的活动性小肠型CD患者进行前瞻性随访，在基线、14周和52周时检测粪便钙卫蛋白（FC）、进行SB-VCE及IUS检查。记录Lewis评分（LS）、Limberg指数（LI）和回肠末端肠壁厚度（TI-BWT），并回顾性计算国际肠道超声节段活动评分（IBUS-SAS）。生化、内镜及超声缓解分别定义为FC < 150 μg/g、LS < 135及LI < 2 + TI-BWT≤3 mm。每个指标的治疗反应定义为与基线相比降低25%。
共纳入71例患者（中位年龄：30岁[23 - 43]，男性占49.3%）。SB-VCE与IUS的中位间隔时间为3天（0 - 25）。最初，LS与TI-BWT（r = 0.647，P <.001）、LI（r = 0.597，P <.001）及IBUS-SAS（r = 0.647，P <.001）密切相关，但这些相关性随时间减弱（TI-BWT：r = 0.344，P =.002；LI：r = 0.471，P =.001；IBUS-SAS：r = 0.236，P =.122）。超声与内镜治疗反应之间存在中度一致性（LS与TI-BWT：K = 0.51，P =.015；LS与LI：K = 0.44，P =.063），缓解方面一致性一般（K = 0.27，P =.006）。轻度（LS≥135）和中重度（LS≥790）炎症的TI-BWT最佳截断值分别为2.25 mm和3.6 mm。
在活动性CD中，IUS测量值与VCE炎症LS密切相关，并可随时间推移对内镜反应及缓解情况进行评估。
