title: Small bowel capsule endoscopy in the management of established Crohn's disease: clinical impact, safety, and correlation with inflammatory biomarkers.
abstract: BACKGROUND
  Multiple studies have established the superior diagnostic accuracy of video capsule endoscopy (VCE) for the diagnosis of small bowel (SB) Crohn's disease (CD). However, data on the clinical impact of VCE in patients with established CD are scarce. The aim of this study was to examine the impact and safety of VCE on the clinical management of patients with established CD.
  
  
  METHODS
  A retrospective, multicenter, cross-sectional study. The study cohort included consecutive patients with established SB CD who underwent VCE in 4 tertiary referral centers (1 Canada, 1 Sweden, and 2 United Kingdom) from January 2008 to October 2013. Patients were excluded if VCE was performed as a part of the initial diagnostic workup. The presence of SB mucosal inflammation was quantified using the Lewis score. Inflammatory biomarkers (C-reactive protein and fecal calprotectin) were measured and correlated with the Lewis score.
  
  
  RESULTS
  The study included 187 patients. No SB inflammation was observed in 28.4%, mild-to-moderate inflammation in 26.6%, and moderate-to-severe inflammation in 45% of the patients (median Lewis score, 662; range, 0-6400). A change in management was recommended in 52.3% of the patients based on VCE findings. Elevated C-reactive protein, fecal calprotectin, or the combination of both were poorly correlated with significant SB inflammation. SB capsule retention occurred in 4 patients (2.1%).
  
  
  CONCLUSIONS
  VCE in patients with established CD is safe, and the results often have a significant clinical impact. VCE should not be limited to CD patients with positive inflammatory markers because their predictive value for significant SB inflammation is poor.
authors.affiliation: *Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada; †Department of Gastroenterology, Skåne University Hospital, Malmö, Lund University, Lund, Sweden; ‡Endoscopy Unit, Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom; §Department of Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust, Chetlenham, United Kingdom; and ‖Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Uri
authors.initials: U
authors.lastname: Kopylov
authors.forename: Artur
authors.initials: A
authors.lastname: Nemeth
authors.forename: Anastasios
authors.initials: A
authors.lastname: Koulaouzidis
authors.forename: Richard
authors.initials: R
authors.lastname: Makins
authors.forename: Gary
authors.initials: G
authors.lastname: Wild
authors.forename: Waqqas
authors.initials: W
authors.lastname: Afif
authors.forename: Alain
authors.initials: A
authors.lastname: Bitton
authors.forename: Gabriele Wurm
authors.initials: GW
authors.lastname: Johansson
authors.forename: Talat
authors.initials: T
authors.lastname: Bessissow
authors.forename: Rami
authors.initials: R
authors.lastname: Eliakim
authors.forename: Ervin
authors.initials: E
authors.lastname: Toth
authors.forename: Ernest G
authors.initials: EG
authors.lastname: Seidman
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000032:analysis*; D053704:Capsule Endoscopy / Q000379:methods*; D003424:Crohn Disease / Q000175:diagnosis* / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D019468:Disease Management; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018836:Inflammation Mediators / Q000032:analysis*; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012449:Safety; D055815:Young Adult
chemical_list: D015415:Biomarkers; D018836:Inflammation Mediators