title: Colon capsule endoscopy compared with other modalities in the evaluation of pediatric Crohn's disease of the small bowel and colon.
abstract: OBJECTIVE
  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. (
  
  
  BACKGROUND
  NCT02199626.).
authors.affiliation: Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Oliva
authors.affiliation: Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Cucchiara
authors.affiliation: Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy.
authors.forename: Fortunata
authors.initials: F
authors.lastname: Civitelli
authors.affiliation: Radiology DEA, Sapienza-University of Rome, Rome, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Casciani
authors.affiliation: Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Nardo
authors.affiliation: Gastrointestinal Endoscopy Unit, Chatolic University of Rome, Rome, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Hassan
authors.affiliation: Pediatric Intensive Care Unit, Sapienza-University of Rome, Rome, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Papoff
authors.affiliation: Children's Center for Digestive Health Care, Atlanta, Georgia, USA.
authors.forename: Stanley A
authors.initials: SA
authors.lastname: Cohen
mesh_terms: D000293:Adolescent; D053704:Capsule Endoscopy / Q000009:adverse effects; D002648:Child; D003092:Colitis / Q000000981:diagnostic imaging*; D003113:Colonoscopy; D003287:Contrast Media; D003424:Crohn Disease / Q000000981:diagnostic imaging*; D004751:Enteritis / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D015588:Observer Variation; D011237:Predictive Value of Tests; D011446:Prospective Studies; D014463:Ultrasonography
chemical_list: D003287:Contrast Media