A128 DIAGNOSTIC YIELD OF CAPSULE ENDOSCOPY AND INFLAMMATORY BOWEL DISEASE SEROLOGY IN PATIENTS WITH ISOLATED COMPLEX PERIANAL FISTULAS
Bibliographic record
Abstract
Complex perianal fistulizing disease is difficult to manage and can lead to significant morbidity. When it occurs in the absence of luminal inflammation, isolated perianal fistulizing disease (IPD) may represent an early manifestation of Crohn’s disease (CD) or idiopathic cryptoglandular fistulas, referred to as fistula in ano. Currently, there are no diagnostic tests to distinguish between these etiologies, which make treatment decisions difficult. Our objectives are to 1) investigate if there is an incremental benefit of capsule endoscopy (CE) above and beyond CTE/MRE for detecting small bowel inflammation, and 2) identify the percentage of patients with positive serologic markers for inflammatory bowel disease (IBD). Consecutive patients referred to a tertiary IBD center with recurrent IPD were included in this observational study. Recurrent IPD was defined as 2 or more episodes of perianal abscesses or persistent perianal fistula drainage for 3 or more months. Patients required complex fistula anatomy by MRI, and a normal luminal evaluation by ileocolonoscopy and CTE/MRE. Patients exposed to non-steroidal inflammatory drugs within 1 month or immunosuppressive medications within 1 year before CE were excluded. Patients underwent CE using PillCam® SB2 and IBD serology from Prometheus Laboratories. CE results were analyzed by Rapid Reader version 2.0 using a predefined data extraction sheet. Diagnosis of luminal CD required one of the following in 1 or more segment(s) of small bowel: diffuse erythema, linear/circumferential ulcers, 3 or more aphthous ulcers, or stenosis. Nineteen patients; 11 males and 8 females, with a median age of 46 years (range 26–80) were included. The fistula anatomy included trans-sphincteric (n=7, 39%) and inter-sphincteric (n=5, 28%). Fistula hyperenhancement was present in 14 patients (78%); and an abscess in 7 (39%). IBD serology was available for 17 patients; 9 (53%) with at least 1 positive marker, 5 (29%) with 2 or more positives, and 2 (12%) with 3 or more positives. Anti-FlaX IgG was the most frequent positive marker. All 19 patients underwent CE without complication. Overall, 3 patients (16%) met our criteria for luminal CD based on presence of 3 or more apthous ulcers. The median Lewis score was 450 (range 17–1518). Two of these patients had IBD serology testing; one had 3 positives, and the other had 0 positives. Based on this observational study in patients with IPD, IBD serological markers are frequently positive, and CE appears to add a small incremental benefit over CTE/MRE for identifying small bowel inflammation. None
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.013 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".