Clinical Impact of Capsule Endoscopy in Patients with Established Crohnʼs Disease
Bibliographic record
Abstract
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.
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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 | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| 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".