A Novel Capsule Endoscopic Score for Crohn’s Disease

Abstract Background and Aims The Lewis Score (LS) and Capsule Endoscopy Crohn’s Disease Activity Index (CECDAI) are the two currently used small bowel capsule endoscopy (SBCE) scoring systems for Crohn’s disease (CD). The present study describes a new scoring system for evaluation of small bowel CD, especially mucosal inflammation. Methods In this cross-sectional study, 108 CD patients underwent 196 SBCEs. The small bowel lesions were scored using our new Crohn’s Disease Activity in Capsule Endoscopy (CDACE). CDACE is the sum of scores for location of inflammation, range of inflammation, and stenosis, with a value ranging from 0 to 1643. We analyzed the relation between CDACE and LS, CECDAI, CDAI, and CRP values and evaluated the inter-rater reliability of CDACE using the intraclass correlation coefficient (ICC) (2.1). Results The mean (±SD) values of LS, CECDAI, and CDACE were 501 ± 1177, 5.8 ± 5.4 and 431 ± 356, respectively. CDACE correlated significantly with LS and CECDAI (ρ = 0.737, P < 0.0001 for LS and ρ = 0.915, P < 0.0001 for CECDAI). CDACE also correlated significantly with CDAI (ρ = 0.36) and CRP (ρ = 0.23). The ICC (2.1) was 0.829, indicating strong agreement among readers. Conclusions CDACE is a potentially useful SBCE scoring system for small bowel CD, as it represents the extent and spread of small bowel mucosal inflammation and stenosis.

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P495 Usefulness of a capsule endoscopy scoring system in understanding the disease state of Crohn’s disease

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.624 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S432-S433

Author(s):

T Omori ◽

H Kambayashi ◽

S Murasugi ◽

A Ito ◽

M Yonezawa ◽

...

Keyword(s):

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Disease Activity ◽

Capsule Endoscopy ◽

Predictive Value ◽

Scoring System ◽

Activity Index ◽

Disease State ◽

Crohn’S Disease Activity

Abstract Background Crohn’s disease (CD) is a pathological condition that develops because of inflammatory and organic changes such as stenosis. The Lewis Score (LS) and Capsule Endoscopy Crohn’s Disease Activity Index (CECDAI) are employed for scoring small bowel lesions in CD using small bowel capsule endoscopy (SBCE). However, it remains unclear whether the obtained score can contribute to the understanding of the disease state or the selection of treatment. This study aimed to examine whether the existing scoring systems (LS and CECDAI) and the new Crohn’s Disease Activity in Capsule Endoscopy (CDACE) scoring system proposed by us were useful in understanding the disease state of CD. Methods After obtaining the results of intestinal patency evaluations using patency capsules from June 2012 to June 2018, 196 times (108 CD patients) who underwent SBCE were included in this retrospective study. The cut-off values of LS, CECDAI, and CDACE were calculated using the receiver operating characteristic curve to determine the extent of small intestinal lesions and the presence or absence of stenotic lesions. Using the cut-off values, the sensitivity (Se), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) of each scoring system were determined. In CDACE, the small bowel is divided into quartiles, and the degree of inflammation (range: 0–4) for each quantile (range: 0–16) (inflammation score: A), number of quartiles with inflammation (range: 0–4) (range score: B), and degree of stenosis (range: 0–3) (stenosis score: C) were scored; the CDACE score was calculated as follows: A × 100 + B × 10 + C (score range: 0–1643). Results For LS, the Se, Sp, PPV, and NPV were 83.7%, 73.5%, 75.9%, and 81.8%, respectively, for inflammation in multiple quantiles (2/3 quantiles or more) (cut-off value: 10) and 94.9%, 90.5%, 71.2%, and 98.6%, respectively, with regard to the presence or absence of stenosis (cut-off value: 196). For CECDAI, the Se, Sp, PPV, and NPV were 93.8%, 86.1%, 82.6%, and 93.4%, respectively, for multiple quantiles (both proximal and distal) (cut-off value: 5) and 51.3%, 87.9%, 51.3%, and 87.9%, respectively, with regard to the presence or absence of stenosis (cut-off value: 11). For CDACE, the Se, Sp, PPV, and NPV were 100%, 82.4%, 78.6%, and 100%, respectively, for multiple quantiles (multiple locations excluding two consecutive zones) (cut-off value: 320) and presence or absence of stenosis was identified in the first digit. Conclusion CECDAI was more likely to predict the extent of inflammation than LS, although it was difficult to determine the presence or absence of stenosis. Based on the scores, CDACE may be a useful scoring system in clinical practice where the disease state of CD needs to be determined.

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The Lewis score or the capsule endoscopy Crohn’s disease activity index: which one is better for the assessment of small bowel inflammation in established Crohn’s disease?

Therapeutic Advances in Gastroenterology ◽

10.1177/1756283x17747780 ◽

2018 ◽

Vol 11 ◽

pp. 1756283X1774778 ◽

Cited By ~ 11

Author(s):

Doron Yablecovitch ◽

Adi Lahat ◽

Sandra Neuman ◽

Nina Levhar ◽

Benjamin Avidan ◽

...

Keyword(s):

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Disease Activity ◽

Capsule Endoscopy ◽

Activity Index ◽

Disease Activity Index ◽

Mucosal Inflammation ◽

Moderate Correlation ◽

Crohn’S Disease Activity

Background Small-bowel capsule endoscopy (CE) is a prime modality for evaluation of the small bowel. The Lewis score (LS) and the Capsule Endoscopy Crohn’s Disease Activity Index (CECDAI) are validated endoscopic indices for quantification of small-bowel inflammation on CE. It is unclear whether these indexes are interchangeable for the evaluation of mucosal inflammation in established Crohn’s disease (CD). The aim of this study was to compare the quantitative evaluation of small- bowel inflammation by LS and CECDAI. Methods Patients with known quiescent small-bowel CD for at least 3 months (Crohn’s disease activity index < 150) were prospectively recruited and underwent CE. The LS was calculated using RAPID 8 capsule-reading software and the CECDAI was calculated manually. Cumulative LS (C-LS) was calculated by summation of individual tertile LS. Fecal calprotectin (FCP) and C-reactive protein (CRP) levels were measured and correlated with the scores. Results A total of 50 patients were included in the study. There was a moderate correlation between the worst segment LS and CECDAI (Pearson’s r = 0.66, p = 0.001), and a strong correlation between C-LS and CECDAI ( r = 0.81, p = 0.0001). CECDAI < 5.4 corresponded to mucosal healing (LS < 135), while CECDAI > 9.2 corresponded to moderate-to-severe inflammation (LS ⩾ 790). There was a moderate correlation between capsule scores and FCP levels ( r = 0.39, p = 0.002 for LS, r = 0.48, p = 0.001 for C-LS, and r = 0.53, p = 0.001 for CECDAI, respectively). CRP levels were not significantly correlated with either score. Conclusions CECDAI and C-LS are strongly correlated and perform similarly for quantitative assessment of mucosal inflammation in established CD.

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