Validity of Capsule Endoscopy in Monitoring Therapeutic Interventions in Patients with Crohn's Disease.

Masanao Nakamura,Yasuyuki Mizutani,Yoshiki Hirooka,Hiroki Kawashima,Tsunaki Sawada,Kazuhiro Furukawa,Keiko Maeda,Ryoji Miyahara,Takuya Ishikawa,Anastasios Koulaouzidis,Eizaburo Ohno,Takeshi Yamamura

doi:10.3390/jcm7100311

Masanao Nakamura, Yasuyuki Mizutani + Show 10 more

Open Access

https://doi.org/10.3390/jcm7100311

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Abstract

Mucosal healing in Crohn’s disease (CD) can be evaluated by capsule endoscopy (CE). However, only a few studies have utilized CE to demonstrate the therapeutic effect of medical treatment. We sought to evaluate the validity of using CE to monitor the effect of medical treatment in patients with CD. One hundred (n = 100) patients with CD were enrolled. All patients had a gastrointestinal (GI) tract patency check prior to CE. Patients with baseline CE Lewis score (LS) ≤ 135 were included in the non-active CD group and ended the study. In those with LS > 135 (active CD group), additional treatment was administered, regardless of symptoms, as per the treating clinician’s advice. Patients of the active CD group underwent follow-up CE assessment 6 months later. Out of 92 patients with confirmed GI patency who underwent CE, 40 (43.4%) had CE findings of active inflammation. Of 29 patients with LS > 135 who received additional medications and underwent follow-up CE, improvement of the LS was noted in 23 (79.3%) patients. Eleven patients were asymptomatic but received additional medications; 8 (72.7%) had improvement of the LS. This study demonstrated that additional treatment even for patients with CD in clinical remission and active small-bowel inflammation on CE can reduce mucosal damage.

Highlights

The main goal in the treatment for Crohn’s disease (CD) is mucosal healing (MH)
The PillCam patency capsule (PPC) consists of lactose and 10% barium, which dissolves when intestinal fluids come into contact with them through a window at the edges of the PPC
PPC is similar to the second-generation Agile patency capsule, with the only difference being that the radiofrequency identification tag has been removed [10] (Figure 1)

Summary

Introduction

The main goal in the treatment for Crohn’s disease (CD) is mucosal healing (MH). MH is predictive of reduced subsequent disease activity and clinical upset, and decreased need for further active treatment [1,2,3]. Several modalities are used in assessing overall disease activity and MH in CD. Faecal calprotectin (FC) is a simple, non-invasive, and readily available tool; its accuracy in evaluating active small-bowel (SB) mucosal lesions in CD has often been debated [4]. Capsule endoscopy (CE) enables physicians to visualize the SB in a non-invasive manner. CE is recommended as the initial diagnostic modality for SB assessment in patients with suspected CD and negative ileocolonoscopy [11]

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