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Mo1582 Capsule Endoscopy: Diagnostic Accuracy of Lewis Score in Patients With Suspected Crohn's Disease
Abstracts
patients swallowed a PC. Diseased segments (DS) on the MRE were evaluated for the following imaging features: mean number of segments, stenosis and prestenotic dilatations, maximal stenosis length, maximal wall thickness and presence of enhancement.The association of these imaging features with the risk of PC retention was evaluated. Results: The radiologist gave a positive prediction of PC retention in 30/57 patients. Actual PC retention occurred in 13/57 patients and was predicted by MRE in 12/13 cases. The sensitivity, specificity, positive and negative predictive values (PPV/NPV) for prediction of PC retention were 92.3%, 59%, 40% and 96.3% respectively.Diseased segments were found in 45 /57 patients. The mean maximal stenosis length (9.7 cm vs 7 cm, pZ0.04) and the mean number of prestenotic dilatations (2 vs 1.1, pZ0.02) were significantly associated with PC retention. One case of symptomatic PC retention occurred in the study which resolved with steroid treatment. No cases of CE retention occurred. Conclusion: MRE has high NPV and sensitivity but low PPV and specificity for PC retention.Capsule retention suggested by MRE should not preclude performance of PC to determine the feasibility and safety of diagnostic CE. Longer stenosed strictures and higher number of prestenotic dilatations on MRE were significantly associated with PC retention.RE, SBH-equal contribution Funded by the Helmsley Charitable Fund
Mo1581 Evaluation Method of Lesions in Small Bowel in Patients With Crohn’s Disease With Preliminary Examination With Patency Capsule Sadaharu Nouda*, Takuya Inoue, Naoki Yorifuji, Munetaka Iguchi, Kazuhiro Ota, Kaori Fujiwara, Shoko Edogawa, Yuichi Kojima, Ken Narabayashi, Toshihiko Okada, Kazuki Kakimoto, Ken Kawakami, Yosuke Abe, Daisuke Masuda, Toshihisa Takeuchi, Kazuhide Higuchi 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan Background and Aim: Small bowel capsule endoscopy (CE) enables observation of lesions in the small bowel in patients with Crohn’s disease (CD). However, lesions in the small bowel cannot be assessed by CE in patients classified as “patency not confirmed”. Therefore, we evaluated the usefulness of a method to assess lesions in the small bowel in patients with CD who had preliminarily undergone examination using a patency capsule. Methods: The subjects were 50 patients who underwent examination using a patency capsule between July 2012 and September 2014 because of CD with lesions in the small bowel. First, all patients underwent examination using a patency capsule. Then, patients classified as “patency not confirmed” based on the results of the examination underwent enteroclysis for assessment of lesions in the small bowel, and patients classified as “patency confirmed” underwent CE. The following two issues were examined: 1) correlation between the LS (Lewis score) (LS) and blood data (leukocytes, hemoglobin, platelets, C-reactive protein [CRP] ) and that between the LS and Crohn’s disease activity index (CDAI), and 2) analysis of the LS in patients with clinical remission defined as CDAI ! 150. Results: The patients’ baseline characteristics were as follows: 39 (78%) were men, age ranging range from 16 to 72 years (mean: 35.2 years) in age, with and a disease duration of 0 to 45 years (mean: 9.5 years); 17 (34%) had small-bowel type and 33 (66%) had small-and-large-bowel type CD; CDAI were was 10 to 329 (mean: 108.9). (1) Seven patients were classified as “patency not confirmed”. Enteroclysis in these patients revealed a stricture due to active lesions at the site corresponding to that of retention of the patency capsule identified by abdominal radiography in six of the patients, as well as narrowing of the anastomotic site without any active lesions in the remaining one patient. (2) Forty-three patients were classified as “patency confirmed” and underwent CE. None of these patients had retention of the patency capsule. The results of CE indicated that the number of ulcers was 4.4 6.2 (mean SD), and the LS was 598.7 1036.6 (mean SD). Assessment of the correlation between the LS and blood data or CDAI revealed a significantly positive correlations between the LS and CRP (CRP; r Z 0.49, P ! 0.01). There were 29 patients with a CDAI ! 150, of whom. Of these, 17 (58.6 %) had an LS O 135, athe value defined as indicative of inflammatory activity. Conclusions: Patency capsules can be used not only to assess the patency of the small bowel, but also to indicate the location of a lesion during enteroclysis. In addition, since clinical remission is not always associated with endoscopic remission, CE is also useful in patients with CD.
Mo1582 Capsule Endoscopy: Diagnostic Accuracy of Lewis Score in Patients With Suspected Crohn’s Disease Sara Monteiro*1, Pedro Boal Carvalho1, Francisca Dias De Castro1, Joana Magalhães1, J. Firmino-Machado2, Maria João Moreira1, Bruno Rosa1, José Cotter1,3 1 Gastroenterology, Alto Ave Hospital Center, Guimarães, Portugal; 2Alto Ave Hospital Center, Guimarães, Portugal; 3Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal Introduction: Small bowel capsule endoscopy (SBCE) has assumed an increasing importance in the diagnosis of Crohn’s Disease (CD). The Lewis Score (LS)
AB474 GASTROINTESTINAL ENDOSCOPY Volume 81, No. 5S : 2015
aims to standardize the method of quantification of small bowel inflammatory activity detected by the capsule. Aims & Methods: The aim of this study was to evaluate the diagnostic accuracy of the LS in patients with suspected CD undergoing SBCE. We performed a retrospective single-center study including 95 consecutive patients who underwent SBCE for suspected CD between September 2006 and February 2013, with at least 12 months of follow-up after the capsule. Patients were grouped according to the criteria of the International Conference on Capsule Endoscopy (ICCE) for the definition of suspected CD. Group 1: 37 patients not fulfilling the minimum requisite of 2 ICCE criteria; Group 2: 58 patients with R 2 ICCE criteria. Inflammatory activity on SBCE was objectively assessed by determining the LS. The confirmation of the diagnosis of CD during follow-up was based on a combination of clinical, analytical, endoscopic, histological and imaging elements. Results: SBCE detected significant inflammatory activity (LS R 135) in 46 patients (48.4%), 7 patients from Group 1 (18.9%) and 39 patients from Group 2 (67.2%) (p ! 0.001).The diagnosis of CD was established during the follow-up in 38 patients (40%): 8 patients (21.6%) from Group 1, 30 patients from Group 2 (51.7%) (p Z 0.003). Among those patients with confirmed diagnosis of CD on follow-up, 34 patients had LS R 135 (73.9%) and 4 patients had LS ! 135 (8.2%) at SBCE (p ! 0.001). The LS R 135 had an overall diagnostic accuracy of 83.2 % with a Sensitivity, Specificity, Positive Predictive Value and Negative Predictive Value for the diagnosis of CD were 89.5%, 78.9%, 73.9% and 91.8%, respectively. Conclusion: The application of LS R 135 as the cut-off value for the presence of significant inflammatory activity in patients undergoing SBCE for suspected CD may be useful to establish the diagnosis in patients with high pretest probability of CD based on an adequate clinical context as defined by the ICCE. In patients with LS ! 135, the probability of having CD confirmed on followup is low.
Mo1583 Clinical Evaluation of Crohn’s Disease in Remission by Capsule Endoscopy Tomoki Hiramoto*, Chiyuki Watanabe, Yuko Hiraga, Masaaki Sumioka Endoscopy, Hiroshima prefectual Hospital, Hiroshima, Japan Background: In patients with quiescent Crohn’s disease (CD), mucosal healing may not be endoscopically achieved, which often leads to exacerbation of symptoms during follow up. Capsule endoscopy (CE) has been contraindicated in Japan for CD due to the risk of retention at strictures of small intestinal lesions. However, the use of patency capsule (PC) to verify patency of the intestinal tract has allowed CE to be performed for CD since July 2012. [Objective] We performed CE after the PC procedure to observe the small intestinal mucosa in patients with quiescent CD and a patent intestinal tract as confirmed by PC. The activity of small intestinal lesions was subsequently assessed on the basis of CE findings, and the efficacy of CE was evaluated to assess clinical outcomes. Subjects and Methods: A total of 33 patients with quiescent CD who underwent the PC procedure and who could be followed up for 6 months or more (25 males, 8 females; average age, 36.2 years) were included. Clinical remission was defined as a CD activity index (CDAI) of ! 150. CE was performed in patients who were identified as having a “patent” intestinal tract by the PC procedure, and active lesions were judged on the basis of CE findings of at least one small ulcer. Patients were followed up for 6 months or more after the PC procedure, and changes in the clinical activity were assessed by comparisons of the estimated CDAI score. We examined associations between CE findings and biomarkers of activity, such as C-reactive protein (CRP) and fecal occult blood. We observed the clinical course for more than 6 months after CE and evaluated clinical activity changes on the basis of CE findings. Results: Among 33 patients who underwent the PC procedure, 22 patients (66.7%) were determined to have a “patent” small intestinal tract and subsequently underwent CE. In eight of these patients (36.4%), active lesions in the small intestine were detected by CE. The presence of active lesions showed no correlation with CDAI scores, CRP levels, or fecal occult blood. Among eight patients with active lesions, three (37.5%) experienced worsening from clinical remission to the active phase within 6 months. On the other hand, 14 patients without active lesions detected by CE remained in clinical remission. Conclusion: In 36.4% of patients with quiescent CD with a patent intestinal tract, active lesions in the small intestine were detected by CE. CE findings were not entirely consistent with CDAI scores, CRP levels, and fecal occult blood. In three (37.5%) of eight patients with active lesions identified by CE, the clinical condition deteriorated within 6 months after the PC procedure, whereas clinical remission was maintained in patients in whom no active lesions had been identified. These findings suggest that CE is a useful examination to predict clinical prognosis of patients with quiescent CD.
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patients swallowed a PC. Diseased segments (DS) on the MRE were evaluated for the following imaging features: mean number of segments, stenosis and prestenotic dilatations, maximal stenosis length, maximal wall thickness and presence of enhancement.The association of these imaging features with the risk of PC retention was evaluated. Results: The radiologist gave a positive prediction of PC retention in 30/57 patients. Actual PC retention occurred in 13/57 patients and was predicted by MRE in 12/13 cases. The sensitivity, specificity, positive and negative predictive values (PPV/NPV) for prediction of PC retention were 92.3%, 59%, 40% and 96.3% respectively.Diseased segments were found in 45 /57 patients. The mean maximal stenosis length (9.7 cm vs 7 cm, pZ0.04) and the mean number of prestenotic dilatations (2 vs 1.1, pZ0.02) were significantly associated with PC retention. One case of symptomatic PC retention occurred in the study which resolved with steroid treatment. No cases of CE retention occurred. Conclusion: MRE has high NPV and sensitivity but low PPV and specificity for PC retention.Capsule retention suggested by MRE should not preclude performance of PC to determine the feasibility and safety of diagnostic CE. Longer stenosed strictures and higher number of prestenotic dilatations on MRE were significantly associated with PC retention.RE, SBH-equal contribution Funded by the Helmsley Charitable Fund
Mo1581 Evaluation Method of Lesions in Small Bowel in Patients With Crohn’s Disease With Preliminary Examination With Patency Capsule Sadaharu Nouda*, Takuya Inoue, Naoki Yorifuji, Munetaka Iguchi, Kazuhiro Ota, Kaori Fujiwara, Shoko Edogawa, Yuichi Kojima, Ken Narabayashi, Toshihiko Okada, Kazuki Kakimoto, Ken Kawakami, Yosuke Abe, Daisuke Masuda, Toshihisa Takeuchi, Kazuhide Higuchi 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan Background and Aim: Small bowel capsule endoscopy (CE) enables observation of lesions in the small bowel in patients with Crohn’s disease (CD). However, lesions in the small bowel cannot be assessed by CE in patients classified as “patency not confirmed”. Therefore, we evaluated the usefulness of a method to assess lesions in the small bowel in patients with CD who had preliminarily undergone examination using a patency capsule. Methods: The subjects were 50 patients who underwent examination using a patency capsule between July 2012 and September 2014 because of CD with lesions in the small bowel. First, all patients underwent examination using a patency capsule. Then, patients classified as “patency not confirmed” based on the results of the examination underwent enteroclysis for assessment of lesions in the small bowel, and patients classified as “patency confirmed” underwent CE. The following two issues were examined: 1) correlation between the LS (Lewis score) (LS) and blood data (leukocytes, hemoglobin, platelets, C-reactive protein [CRP] ) and that between the LS and Crohn’s disease activity index (CDAI), and 2) analysis of the LS in patients with clinical remission defined as CDAI ! 150. Results: The patients’ baseline characteristics were as follows: 39 (78%) were men, age ranging range from 16 to 72 years (mean: 35.2 years) in age, with and a disease duration of 0 to 45 years (mean: 9.5 years); 17 (34%) had small-bowel type and 33 (66%) had small-and-large-bowel type CD; CDAI were was 10 to 329 (mean: 108.9). (1) Seven patients were classified as “patency not confirmed”. Enteroclysis in these patients revealed a stricture due to active lesions at the site corresponding to that of retention of the patency capsule identified by abdominal radiography in six of the patients, as well as narrowing of the anastomotic site without any active lesions in the remaining one patient. (2) Forty-three patients were classified as “patency confirmed” and underwent CE. None of these patients had retention of the patency capsule. The results of CE indicated that the number of ulcers was 4.4 6.2 (mean SD), and the LS was 598.7 1036.6 (mean SD). Assessment of the correlation between the LS and blood data or CDAI revealed a significantly positive correlations between the LS and CRP (CRP; r Z 0.49, P ! 0.01). There were 29 patients with a CDAI ! 150, of whom. Of these, 17 (58.6 %) had an LS O 135, athe value defined as indicative of inflammatory activity. Conclusions: Patency capsules can be used not only to assess the patency of the small bowel, but also to indicate the location of a lesion during enteroclysis. In addition, since clinical remission is not always associated with endoscopic remission, CE is also useful in patients with CD.
Mo1582 Capsule Endoscopy: Diagnostic Accuracy of Lewis Score in Patients With Suspected Crohn’s Disease Sara Monteiro*1, Pedro Boal Carvalho1, Francisca Dias De Castro1, Joana Magalhães1, J. Firmino-Machado2, Maria João Moreira1, Bruno Rosa1, José Cotter1,3 1 Gastroenterology, Alto Ave Hospital Center, Guimarães, Portugal; 2Alto Ave Hospital Center, Guimarães, Portugal; 3Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal Introduction: Small bowel capsule endoscopy (SBCE) has assumed an increasing importance in the diagnosis of Crohn’s Disease (CD). The Lewis Score (LS)
AB474 GASTROINTESTINAL ENDOSCOPY Volume 81, No. 5S : 2015
aims to standardize the method of quantification of small bowel inflammatory activity detected by the capsule. Aims & Methods: The aim of this study was to evaluate the diagnostic accuracy of the LS in patients with suspected CD undergoing SBCE. We performed a retrospective single-center study including 95 consecutive patients who underwent SBCE for suspected CD between September 2006 and February 2013, with at least 12 months of follow-up after the capsule. Patients were grouped according to the criteria of the International Conference on Capsule Endoscopy (ICCE) for the definition of suspected CD. Group 1: 37 patients not fulfilling the minimum requisite of 2 ICCE criteria; Group 2: 58 patients with R 2 ICCE criteria. Inflammatory activity on SBCE was objectively assessed by determining the LS. The confirmation of the diagnosis of CD during follow-up was based on a combination of clinical, analytical, endoscopic, histological and imaging elements. Results: SBCE detected significant inflammatory activity (LS R 135) in 46 patients (48.4%), 7 patients from Group 1 (18.9%) and 39 patients from Group 2 (67.2%) (p ! 0.001).The diagnosis of CD was established during the follow-up in 38 patients (40%): 8 patients (21.6%) from Group 1, 30 patients from Group 2 (51.7%) (p Z 0.003). Among those patients with confirmed diagnosis of CD on follow-up, 34 patients had LS R 135 (73.9%) and 4 patients had LS ! 135 (8.2%) at SBCE (p ! 0.001). The LS R 135 had an overall diagnostic accuracy of 83.2 % with a Sensitivity, Specificity, Positive Predictive Value and Negative Predictive Value for the diagnosis of CD were 89.5%, 78.9%, 73.9% and 91.8%, respectively. Conclusion: The application of LS R 135 as the cut-off value for the presence of significant inflammatory activity in patients undergoing SBCE for suspected CD may be useful to establish the diagnosis in patients with high pretest probability of CD based on an adequate clinical context as defined by the ICCE. In patients with LS ! 135, the probability of having CD confirmed on followup is low.
Mo1583 Clinical Evaluation of Crohn’s Disease in Remission by Capsule Endoscopy Tomoki Hiramoto*, Chiyuki Watanabe, Yuko Hiraga, Masaaki Sumioka Endoscopy, Hiroshima prefectual Hospital, Hiroshima, Japan Background: In patients with quiescent Crohn’s disease (CD), mucosal healing may not be endoscopically achieved, which often leads to exacerbation of symptoms during follow up. Capsule endoscopy (CE) has been contraindicated in Japan for CD due to the risk of retention at strictures of small intestinal lesions. However, the use of patency capsule (PC) to verify patency of the intestinal tract has allowed CE to be performed for CD since July 2012. [Objective] We performed CE after the PC procedure to observe the small intestinal mucosa in patients with quiescent CD and a patent intestinal tract as confirmed by PC. The activity of small intestinal lesions was subsequently assessed on the basis of CE findings, and the efficacy of CE was evaluated to assess clinical outcomes. Subjects and Methods: A total of 33 patients with quiescent CD who underwent the PC procedure and who could be followed up for 6 months or more (25 males, 8 females; average age, 36.2 years) were included. Clinical remission was defined as a CD activity index (CDAI) of ! 150. CE was performed in patients who were identified as having a “patent” intestinal tract by the PC procedure, and active lesions were judged on the basis of CE findings of at least one small ulcer. Patients were followed up for 6 months or more after the PC procedure, and changes in the clinical activity were assessed by comparisons of the estimated CDAI score. We examined associations between CE findings and biomarkers of activity, such as C-reactive protein (CRP) and fecal occult blood. We observed the clinical course for more than 6 months after CE and evaluated clinical activity changes on the basis of CE findings. Results: Among 33 patients who underwent the PC procedure, 22 patients (66.7%) were determined to have a “patent” small intestinal tract and subsequently underwent CE. In eight of these patients (36.4%), active lesions in the small intestine were detected by CE. The presence of active lesions showed no correlation with CDAI scores, CRP levels, or fecal occult blood. Among eight patients with active lesions, three (37.5%) experienced worsening from clinical remission to the active phase within 6 months. On the other hand, 14 patients without active lesions detected by CE remained in clinical remission. Conclusion: In 36.4% of patients with quiescent CD with a patent intestinal tract, active lesions in the small intestine were detected by CE. CE findings were not entirely consistent with CDAI scores, CRP levels, and fecal occult blood. In three (37.5%) of eight patients with active lesions identified by CE, the clinical condition deteriorated within 6 months after the PC procedure, whereas clinical remission was maintained in patients in whom no active lesions had been identified. These findings suggest that CE is a useful examination to predict clinical prognosis of patients with quiescent CD.
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