Original article
Clinical endoscopy
Colon capsule endoscopy compared with other modalities in the evaluation of pediatric Crohn’s disease of the small bowel and colon

https://doi.org/10.1016/j.gie.2015.08.070Get rights and content

Background and Aims

Data on colon capsule endoscopy (CCE) in evaluating the small bowel and colon concurrently are rare. This study aimed to evaluate the accuracy of CCE in assessing disease activity of the small bowel and colon in pediatric Crohn’s disease (CD) by comparison with magnetic resonance enterography (MRE), small-intestine contrast US (SICUS), and ileocolonoscopy.

Methods

We prospectively enrolled 40 consecutive patients (22 male, 18 female, mean age 13.1 ± 3.1 years) with CD of the small bowel and colon. All underwent SICUS, MRE, CCE, and ileocolonoscopy sequentially over 5 days. All investigators were blinded to patient history and test results. Patients were classified as active or inactive for the small bowel and the colon according to specific criteria for each tool (simple endoscopic score for CD, Lewis score, US and magnetic resonance parameters of activity). For colon mucosa evaluation, ileocolonoscopy was the comparator. For the small bowel, a consensus panel was convened.

Results

Sensitivity of CCE to detect colon inflammation was 89%, and specificity was 100%. The positive predictive value (PPV) and negative predictive value (NPV) of CCE for colon inflammation were 100% and 91%, respectively. In the small bowel, CCE showed 90% sensitivity, 94% specificity, with PPV and NPV of 95% and 90%, respectively. Accuracy parameters for SICUS (sensitivity 90%, specificity 83%) and MRE (sensitivity 85%, specificity 89%) were lower than those for CCE. No serious adverse events related to the CCE procedure or preparation were reported.

Conclusions

CCE is of great usefulness in evaluating both small bowel and colon mucosa in pediatric CD. This single, noninvasive tool makes it possible to evaluate the small-bowel and the colon concurrently with high diagnostic accuracy. Future multicenter studies need to define the role of CCE in the routine management of pediatric patients with CD. (Clinical trial registration number: NCT02199626.)

Section snippets

Patients

Eligible patients were recruited at the Pediatric Gastroenterology and Liver Unit of the Sapienza University of Rome, a tertiary-care referral pediatric center for inflammatory bowel disease (IBD), between September 2013 and July 2014. Inclusion criteria were as follows: age 6 to 18 years, diagnosis of CD at least 3 months before enrollment, and need for endoscopy and imaging follow-up. Exclusion criteria were as follows: dysphagia, renal insufficiency, known stricturing CD identified by

Primary endpoint

The intent of the study was to assess disease activity in the small bowel and colon, classify pediatric CD patients as normal or with active inflammation, and to calculate the diagnostic accuracy of CCE. Colon disease activity was assessed according to the simple endoscopic score for CD19 that was calculated for each colon segment; the overall score for each patient was obtained by adding the scores of each individual segment. For our primary end-point and according to the literature, we

Results

Of 40 patients enrolled (22 male, 18 female, mean age 13.1 ± 3.1 years; mean disease duration: 37.3 ± 26.1 months), 2 patients were excluded because of inability to swallow the capsule, leaving 38 patients available for analysis (Fig. 1, Table 1). Thirty patients underwent colonoscopy in the afternoon of the day of CCE, whereas 8 patients proceeded the day after, because of the lack of capsule excretion before the end of battery life.

Discussion

This study, which used CCE in pediatric patients with Crohn’s disease, demonstrated the ability of a single, minimally invasive tool to evaluate the mucosa of both the small bowel and the colon concurrently with high diagnostic accuracy, safety, and tolerability, enabling the ability to monitor mucosal activity of the entire intestinal tract in a manner that previously required both standard capsule endoscopy and colonoscopy in pediatric patients.

CCE performed well in the colon, providing

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    DISCLOSURE: C. Hassan and S. Cohen are consultants for Given Imaging. All other authors disclosed no financial relationships relevant to this article.

    If you would like to chat with an author of this article, you may contact Dr Oliva at [email protected].

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