The role of small bowel capsule endoscopy and patency capsule, in the diagnosis and monitoring of patients with inflammatory bowel diasease (IBD) (Doctoral thesis)

Μητσέλος, Ιωάννης

Ileocolonoscopy (IC), Small Bowel Capsule Endoscopy (SBCE) and Magnetic Resonance Enterography (MRE), are essential tools in the investigation of suspected and established Crohn's disease (CD). AIM: To investigate the role, the diagnostic performance and the additional diagnostic benefit of SBCE over IC in suspected CD, to investigate the relationship of C-reactive protein (CRP), Crohn's Disease Activity Index (CDAI) and SBCE inflammation scoring index (Lewis Score, LS), as well as, to compare SBCE with MRE in CD extent evaluation, in patients with established CD. PATIENTS AND METHODS: This was a retrospective study of 91 patients withsuggestive symptoms for CD (chronic abdominal pain and/or diarrhea), as well as of 55 patients with established CD [30 patients with isolated small bowel (SB) CD (L1) and 25 patients with ileocolonic CD (L3)], who underwent SBCE as part of the diagnostic workup or for the evaluation of disease extend and activity. All patients were evaluated with colonoscopy and SBCE. Data regarding colonoscopy, SBCE, MRE, CDAI and CRP were retrieved from our academic institution patient records and were analyzed statistically. SBCE inflammation severity was evaluated with LS. RESULTS: In patients with suspected CD, the performance of IC and SBCE in CD diagnosis (SB or colonic) was: Sensitivity 81.8 and 63.6%; Specificity 77.5 and 92.5%; Positive Predictive Value (PPV) 33.3 and 53.85%; Negative Predictive Value (NPV) 96.9% and 94.9%; Area under the receiver operating characteristic curve (AUC) 0.797 and 0.781, respectively. In patients with established CD, SBCE identified significant mucosal inflammation, in 9 out of 15 (60.0%) L1 patients [mean (SD) LS: 1599 (1380)] and in 8 out of 11 (72.7%) L3 patients, who were in both clinical and biochemical remission. In L1 patients, the correlation of CDAI and CRP with LS was: r=0.317, p=0.088 and r=0.516, p=0.004, respectively. The diagnostic performance of CDAI and CRP inpredicting endoscopic inflammatory activity was: Sensitivity 23.8 and 52.4%; Specificity 100 and 66.7%; PPV 100 and 78.6%; NPV 36.0 and 37.5%; AUC 0.70 and 0.69, respectively. Seventeen patients with established CD underwent both MRE and SBCE. In 2 patients SBCE identified inflammation of the proximal SB, which was undetected by MRE and revealed the true extent of disease in 9 out of the aforementioned 55 patients with established CD. CONCLUSION: In patients with nonspecific, but suggestive symptoms for CD, SBCE offered additional information regarding inflammatory activity and disease extent. However, the additional diagnostic benefit in patients with sufficient terminal ileum visualization during colonoscopy, was little. Both CDAI and CRP ability to predict endoscopic activity was limited. MRE and SBCE demonstrated similar performance in disease extent evaluation, however SBCE performed better in the identification of proximal CD.
Institution and School/Department of submitter: Πανεπιστήμιο Ιωαννίνων. Σχολή Επιστημών Υγείας. Τμήμα Ιατρικής
Subject classification: Νόσος Crohn
Keywords: Νόσος Crohn,κάψουλα λεπτού εντέρου,ιδιοπαθής φλεγμονώδη νοσήματα των εντέρων,ΙΦΝΕ,small bowel capsule endoscopy,Crohn's disease,idiopathic inflammatory bowel disease,IBD
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