Clinical Benefit of Capsule Endoscopy in Crohnʼs Disease: Impact on Patient Management and Prevalence of Proximal Small Bowel Involvement
Bibliographic record
Abstract
Introduction: CT/MR enterography (CT/MRE) are at the forefront of small bowel (SB) Crohn's disease (CD) diagnosis and disease activity assessment. However, capsule endoscopy (CE) is more sensitive for mucosal disease and upper gastrointestinal tract CD than CT/MRE. There is a paucity of data regarding how CE impacts patient care in CD patients (pts) undergoing evaluations with ileocolonoscopy (IC) and CT/MRE. Methods: We prospectively analyzed 50 adult CD pts with established CD undergoing clinically indicated IC and CT/MRE. IBD Clinic providers completed pre- and post-imaging questionnaires regarding indication for imaging and proposed management plans. Providers were asked whether active SB disease and mucosal ulcerations were present and their level of confidence (LOC) for each on a 5-point scale. The post-imaging questionnaire addressed whether CE findings altered management plans, nature of alterations, and whether LOC changes were due to CE findings. A change of >2 on LOC scale was considered clinically meaningful. Proximal SB disease on CE was defined as CD findings within first half of SB transit time and extensive disease was defined as proximal and distal SB involvement. Pts with strictures on IC or CT/MRE were excluded. Results: A total of 383 pts were screened; 93 excluded for SB stricturing on imaging or prior obstruction. Of the 50 eligible pts evaluated (60% females), median age was 38.0 years, median disease duration was 3 years (range 0-30 years), and median CD activity index was 237.5. Most common indication for imaging was assessment of disease extent (64.0%). All CT/MRE studies were negative for proximal disease. CE detected proximal disease in 14 (28%) pts with a median Lewis score of 214.5 and 6 pts had extensive SB disease with a median Lewis score of 519.5. Median Lewis score for all pts was 0. No CE-related adverse events occurred. CE findings altered management in 17 cases (34.0%). Most frequent physicianperceived changes were addition of new medication (29.4%) and exclusion of active SB mucosal disease (29.4%). LOC changes were related to CE in 82% of cases with clinically meaningful LOC changes observed in 56% of encounters. Conclusion: CE is a valuable, safe, radiation free imaging modality that can alter management plans and provider LOC for detection of SB inflammation in pts with established CD once strictures are excluded by CT/MRE. These findings further support the use of CE in CD diagnostic management algorithms.
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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 | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 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".