Development and validation of a scoring index to predict the presence of lesions in capsule endoscopy in patients with suspected Crohn’s disease of the small bowel: a Spanish multicenter study

Valenzuela, Juan Egea; Suárez, Begoña González; Bernal, Cristian Sierra; Fernández, José María Díaz; Luján-Sanchis, Marisol; Acosta, M San Juan; Andrés, Bruno; Beltrán, Vicente Pons; Lozano, Violeta María Sastre; Ribón, Cristina Carretero; Almenar, Félix de Vera; Cuenca, Joaquín Sánchez; Parras, Fernando Alberca de Las; Miguel, Cristina Rodríguez de; Muñoz, Julio Valle; Sainz, Ignacio Fernández-Urién; González, Carolina Torres; Barrera, Pilar Borque; Robles, Enrique Pérez‐Cuadrado; Lázaro, Noelia Alonso; García, Pedro López; Frías, César Prieto de; Álvarez, F. Carballo

doi:10.1097/meg.0000000000001083

Cited by 8 publications

(3 citation statements)

References 29 publications

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“…Symptoms alone are a poor predictor of CD. The International Conference on Capsule Endoscopy (ICCE) [117] recommended a broader definition of suspected CD that includes inflammatory markers, abnormal imaging, and/or extraintestinal manifestations [118,119]. It has also been demonstrated that ICCE criteria can be used as an effective selection tool for SBCE since patients with fewer than two ICCE criteria are not only unlikely to have inflammatory changes in the small bowel but also to be diagnosed with CD in the follow-up [118].…”

Section: Recommendationmentioning

confidence: 99%

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

et al. 2022

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Main Recommendations MR1 ESGE recommends small-bowel capsule endoscopy as the first-line examination, before consideration of other endoscopic and radiological diagnostic tests for suspected small-bowel bleeding, given the excellent safety profile of capsule endoscopy, its patient tolerability, and its potential to visualize the entire small-bowel mucosa.Strong recommendation, moderate quality evidence. MR2 ESGE recommends small-bowel capsule endoscopy in patients with overt suspected small-bowel bleeding as soon as possible after the bleeding episode, ideally within 48 hours, to maximize the diagnostic and subsequent therapeutic yield.Strong recommendation, high quality evidence. MR3 ESGE does not recommend routine second-look endoscopy prior to small-bowel capsule endoscopy in patients with suspected small-bowel bleeding or iron-deficiency anemia.Strong recommendation, low quality evidence. MR4 ESGE recommends conservative management in those patients with suspected small-bowel bleeding and high quality negative small-bowel capsule endoscopy.Strong recommendation, moderate quality evidence. MR5 ESGE recommends device-assisted enteroscopy to confirm and possibly treat lesions identified by small-bowel capsule endoscopy.Strong recommendation, high quality evidence. MR6 ESGE recommends the performance of small-bowel capsule endoscopy as a first-line examination in patients with iron-deficiency anemia when small bowel evaluation is indicated.Strong recommendation, high quality evidence. MR7 ESGE recommends small-bowel capsule endoscopy in patients with suspected Crohn’s disease and negative ileocolonoscopy findings as the initial diagnostic modality for investigating the small bowel, in the absence of obstructive symptoms or known bowel stenosis.Strong recommendation, high quality evidence. MR8 ESGE recommends, in patients with unremarkable or nondiagnostic findings from dedicated small-bowel cross-sectional imaging, small-bowel capsule endoscopy as a subsequent investigation if deemed likely to influence patient management.Strong recommendation, low quality evidence. MR9 ESGE recommends, in patients with established Crohn’s disease, the use of a patency capsule before small-bowel capsule endoscopy to decrease the capsule retention rate.Strong recommendation, moderate quality evidence. MR10 ESGE recommends device-assisted enteroscopy (DAE) as an alternative to surgery for foreign bodies retained in the small bowel requiring retrieval in patients without acute intestinal obstruction.Strong recommendation, moderate quality evidence. MR11 ESGE recommends DAE-endoscopic retrograde cholangiopancreatography (DAE-ERCP) as a first-line endoscopic approach to treat pancreaticobiliary diseases in patients with surgically altered anatomy (except for Billroth II patients).Strong recommendation, moderate quality evidence.

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Section: Recommendationmentioning

confidence: 99%

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

et al. 2022

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“…1 Score ranges 0 to 5, 6 to 15, and ≥16 predicted low, intermediate, and high risk of inflammatory lesions on VCE, respectively. 61…”

Section: Resultsmentioning

confidence: 99%

“…1 Score ranges 0 to 5, 6 to 15, and !16 predicted low, intermediate, and high risk of inflammatory lesions on VCE, respectively. 61 Another elegant study has shown the incremental yield of VCE with an increasing number of International Conference on Capsule Endoscopy (ICCE) criteria. Suspected CD was defined as clinical symptoms (chronic abdominal pain/diarrhea, weight loss, and growth failure) plus any one or more extraintestinal manifestations, inflammatory markers, and abnormal imaging (SBFT/CTE).…”

Section: Factors Affecting Yield Of Video Capsule Endoscopy In Suspec...mentioning

confidence: 99%

Capsule Endoscopy in Inflammatory Bowel Disease: A Systematic Review

Pal,

Banerjee,

Gupta

et al. 2023

Journal of Digestive Endoscopy

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The role of video capsule endoscopy (VCE) in inflammatory bowel disease (IBD) has evolved from small bowel to a panenteric evaluation tool over the past two decades. We systematically reviewed the techniques, applications, outcomes, and complications of VCE in IBD. A systematic literature search was performed using PubMed, Embase, and Medline. All relevant original articles involving VCE in IBD were included from 2003 to July 2022. After screening 3,089 citations, finally 201 references were included. The diagnostic yield of VCE in suspected Crohn's disease (CD) was highly variable (6–80%) with excellent sensitivity (77–93%) and specificity (80–89%). The diagnostic yield in known CD was 52 to 88.3% leading to a change in management (26–75%) and disease reclassification with variable retention rates. VCE was superior to small bowel series, computed tomography (CT) and could be better than magnetic resonance enterography (MRE), especially for proximal and superficial lesions. Colon or panenteric VCE has strong correlation to ileo-colonoscopy (IC) and combined magnetic resonance imaging and IC, respectively. The VCE retention rate in CD is higher in known CD which significantly decreases after the negative patency capsule test or CT/MRE. VCE can identify lesions beyond the reach of IC in postoperative CD. Colon Capsule Endoscopy is a noninvasive monitoring tool in ulcerative colitis (UC) having a strong correlation with IC and may uncover small bowel involvement. VCE is specifically useful in IBD-unclassified (IBD-U) which can lead to the diagnosis of CD in 16.7 to 61.5%. Various scoring systems have been established and validated for small bowel CD (Lewis score and capsule endoscopy CD activity index—CECDAI), UC (capsule scoring of UC: Capsule Scoring of Ulcerative Colitis), panenteric evaluation (Capsule Endoscopy Crohn's Disease Activity Index, Elaikim score), and flare prediction (APEX score). Technological advances include double head, three-dimensional reconstruction, sampling system, panoramic view (344 and 360 degree lateral), and panenteric capsule. Artificial intelligence and software like TOP100 and Quickview can help reduce capsule reading time with excellent sensitivity and specificity. VCE in IBD has widespread application in suspected and known small bowel CD, monitoring of UC, postoperative CD, IBD-U, and for panenteric evaluation. Patency capsule testing helps to reduce retention rates significantly. Artificial intelligence and technical advances can help evolve this novel technology.

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Crohn’s Disease Only Visible on Small Bowel Capsule Endoscopy: A New Entity

et al. 2020

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Development and validation of a scoring index to predict the presence of lesions in capsule endoscopy in patients with suspected Crohn’s disease of the small bowel: a Spanish multicenter study

Abstract: Results from the internal validation process show that the scoring index is coherent, and results from the external validation process confirm its reliability. This index can be a useful tool for selecting patients before CE studies in cases of suspected CD of the small bowel.

Cited by 8 publications

References 29 publications

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

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

Capsule Endoscopy in Inflammatory Bowel Disease: A Systematic Review

Crohn’s Disease Only Visible on Small Bowel Capsule Endoscopy: A New Entity

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