P727 Small bowel capsule endoscopy impact on therapeutic decisions in established Crohn’s disease: Analysis of a real-world data
Bibliographic record
Abstract
Abstract Background Small bowel (SB) evaluation in established Crohn’s disease (eCD) is of paramount importance for planning therapy strategies. However, the utility of CE in helping physicians to make decisions in eCD is not currently well established. To investigate clinical impact of CE to assess activity and extension of eCD and to evaluate whether the results of CE modify therapeutic decisions. Methods We conducted a single centre retrospective cohort study. All consecutive adult’s patients submitted to CE for eCD were included from November 2012 to November 2018. Data on demography, previous research, medications for IBD and follow-up were analysed. Univariate analysis was carried out to identify CE features associated with changes in therapeutic management. Results A total of 329 CE protocols in adult′s patients were performed, of which 90 were in IBD. We included in the analysis 27 CEs submitted for eCD. The mean age was 35 years (range 15–75), 17 (63%) were males and median disease duration was 8 years. The CE reached the cecum in 26 cases (96%) and retention was observed in only one patient (4%) without necessity of surgical removal. At the time of CE, 5 patients (18%) had abnormal inflammatory biomarkers, anaemia in 4 (15%), abdominal pain in 18 (67%) and diarrhoea in 16 (59%). Thirteen of 27 patients (48%) had CE findings consistent with mucosal activity of CD. The lesions identified by CE included ulcers 11 (41%), erythema and villous enema 10 (37%), erosions 2 (7%), stenosis 2 (7%) and were distributed mainly in the distal part of the SB (3rd tertile) in 12 (44%), but in 4 (15%) the proximal SB (1st and 2nd tertile) was also affected. The mean Lewis Score (LS) was 784 (8–5392). Significant inflammatory activity (LS ≥ 135) was detected in 9 (33%) and was moderate or severe (LS > 790) in 2 (7%). CE has changed Montreal classification in 4 (15%) of patients and in 14 (52%) SB mucosal activity was ruled out. Indeed, CE has changed therapeutic management in 14 (52%) of patients within 3 months after the CE, as follows: 8 patients were started new biological therapy, 3 were optimised biological therapy, 2 were started on budesonide and 1 suspended azathioprine. Proximal SB affected, as compared with only distal SB affected, were more frequently associate with changes in therapeutic management (100% vs. 43%, p: 0.04). Significant inflammatory activity (LS ≥ 135), as compared with LS < 135, were also more frequently associate with changes in therapeutic management (82% vs. 25%, p: 0.004). Conclusion In our study, CE in patients with eCD added valuable clinical information and had a great impact on therapeutic decisions. Whether this approach will improve outcomes in eCD will require further investigation.
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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 | 0.003 | 0.012 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 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".