Clinical Impact of Capsule Endoscopy in Patients with Established Crohnʼs Disease
Notice bibliographique
Résumé
Purpose: Videocapsule endoscopy (VCE) enables excellent visualization of the entire small bowel mucosa in a non-invasive fashion. Metanalyses have established that the accuracy of VCE for the diagnosis of Crohn's disease (CD) is superior to ileocolonoscopy and CT enterograpy. This modality may be also useful in patients with an established diagnosis of CD. However, scarce data exist of the impact of VCE findings on the management of patients with established CD. The aim of this study is to examine the impact of VCE on the management of patients with established CD. Methods: Retrospective cross-sectional study in a tertiary IBD center. The study cohort included all consecutive patients (1/2009-3/2013) with established CD who underwent VCE. Clinical and demographic data were extracted from patients' files and electronic records. All the capsule endoscopy studies were performed using the SB II capsule (Given Imaging, Yokneam, Israel) after administration of a patency capsule (PC). The presence of small bowel mucosal inflammation on VCE was quantified using the Lewis score (LS). Results: Twenty-eight patients with CD were included in the study. The PC was eliminated from the small bowel after 30 hours in 24/28 (85.7%) patients (age 33±13 years; 75% female; age of onset 24±12 years). Disease location: ileal 38%, ileocolonic 42%, colonic 20%. VCE was performed for the following indications: unexplained symptoms (62.5%), assessment of extent of small bowel disease in patients with known colonic or terminal ileal disease (20%), evaluation of unexplained anemia (4%), and evaluation of mucosal healing in patients in clinical remission (17%). Inflammatory markers (CRP or fecal calprotectin) were elevated in 55% of the patients. VCE was normal in 25% of the patients. The exam was consistent with mild and moderate to severe enteritis in 29% and 46%, respectively, with mean LS of 1,429±1,521. The management of the patients was changed as a result of VCE findings in 67% of the patients. Management changes included escalation of medical therapy (anti-TNF agent initiated in 25%, anti-TNF dose escalated in 12.5%, azathioprine initiated in 25%, enteric coated budesonide initiated in 6.25% and tacrolimus initiated in 6.25% of the patients), referral for surgery in 6.25% of the patients and de-escalation of anti-inflammatory therapy or initiation of therapy for concomitant IBS in 18.75% of the patients. Small bowel disease was diagnosed in 40% of patients by VCE initially diagnosed with isolated colonic CD. No capsule retentions occurred. Conclusion: VCE findings had a significant impact on treatment of patients with established Crohn's disease and should be considered a very safe and valuable tool in evaluation and management of these patients. Disclosure - Dr. Bessissow - Speaker: Shire, Janssen, Takeda, Aptalis Consultant: Shire, Janssen, Abbvie Dr. Seidman - Speaker - Abbvie, Janssen, Given; Consultant - Given, Jannsen, Abbvie.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».