Assessment of disease severity on capsule endoscopy in patients with small bowel villous atrophy

Abstract

Background and Aim: There is a lack of uniformity of reporting on features of celiac disease (CD) on small bowel capsule endoscopy (SBCE). This makes determining extent of disease and comparison of severity of disease challenging. Methods: De-identified SBCEs of 300 patients (78 CD [26%], 18 serology negative villous atrophy [6%], and 204 controls with normal duodenal histology [68%]) were included. Videos were reviewed by two experts. All patients had duodenal histology taken within 2 weeks of SBCE. The degree of agreement in CD features and extent of disease was then determined. The resulting score for each factor was used to determine overall severity of disease.Results: There was substantial agreement in the kappa coefficient for the detection of CD features between reviewers (0.67). Agreement for extent of affected small bowel (SB) mucosa was high (0.97). On multiple regression analysis, several features of CD correlated with extent of affected SB mucosa for both reviewers. The odds ratios derived from this analysis were then used to score features of CD, enabling scores of severity to be calculated for each patient. The median overall scores for patients increased significantly according to the independent classification of severity by the capsule reviewers: mild (20, 0-79), moderate (45,, and severe (89, 65-130) (P = 0.0001). Conclusion:The good correlation of CD scores between expert reviewers confirms the validity of features of CD on SBCE. An objective score of CD features in the SB is useful in the follow up of patients with CD and serology negative villous atrophy.

Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2022

“…As with the previous ESGE guideline 1 , there is no new evidence supporting the use of SBCE to routinely map the extent of disease. However, two recent studies from Chetcuti Zammit et al 244 245 reported that the extent of villous atrophy could be efficiently verified by SBCE and atrophy extent could correlate with clinical parameters in some specific subgroups of patients (e. g., those with nonresponsive celiac disease, or severe bone involvement). The first study analyzed SBCE in 300 celiac patients and demonstrated an acceptable agreement among readers to define the severity of celiac disease 244 ; the second analyzed a cohort of 80 celiac patients and showed that, in individuals with a relevant percentage of small bowel involved by villous atrophy, bone mineral density decreased significantly 245 ; furthermore, bone mineral density did not correlate with histological severity of atrophy, underlining the potential relevance of atrophy extent.…”

Artificial intelligence within the small bowel: are we lagging behind?

“…Unless standards in demographics and extent of disease are adhered to [49,50], this will contribute to error propagation and the output algorithm from the machine will also be skewed. A bigger challenge exists in certain conditions such as coeliac disease where there is no standard in reporting on findings in the small bowel and lesions can vary in extent and severity [51,52]. Several limitations exist in recent studies on the use of artificial intelligence in SBCE.…”

Nomenclature and Definition of Atrophic Lesions in Small Bowel Capsule Endoscopy: A Delphi Consensus Statement of the International CApsule endoscopy REsearch (I-CARE) Group

“…These endoscopic findings suggest the presence of SB mucosal atrophy that is usually, but not always, associated with CeD [ 9 ]. However, the features of SB atrophy at SBCE are not described uniformly, and currently atrophy signs are mainly identified and verified by experts [ 10 ].…”