Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

The Role of Small-Bowel Capsule Endoscopy in the Diagnostic Algorithm of Complicated Perianal Disease

Avni-Biron, Irit ; Toth, Ervin LU ; Ollech, Jacob E. ; Nemeth, Artur LU ; Johansson, Gabriele Wurm LU ; Schweinstein, Hagai ; Margalit, Reuma Yehuda ; Kopylov, Uri ; Dotan, Iris and Yanai, Henit (2024) In Diagnostics 14(16).
Abstract

Introduction: Complicated perianal disease (cPD) may be the sole presentation of Crohn’s disease (CD). The role of small-bowel capsule endoscopy (SBCE) in the diagnostic algorithm of cPD is unclear. We aimed to evaluate the role of SBCE as a diagnostic tool, in patients with cPD, after a negative standard workup for CD. Methods: A multicenter, retrospective, cross-sectional study, in patients with cPD, and negative standard workup for CD (ileocolonoscopy and cross-sectional imaging), who underwent SBCE for suspected CD. Demographics, biomarkers, and the Lewis Score (LS) were recorded and analyzed. An LS ≥ 135 was considered a positive SBCE for diagnosing CD. Results: Ninety-one patients were included: 65 (71.4%) males; median age: 37... (More)

Introduction: Complicated perianal disease (cPD) may be the sole presentation of Crohn’s disease (CD). The role of small-bowel capsule endoscopy (SBCE) in the diagnostic algorithm of cPD is unclear. We aimed to evaluate the role of SBCE as a diagnostic tool, in patients with cPD, after a negative standard workup for CD. Methods: A multicenter, retrospective, cross-sectional study, in patients with cPD, and negative standard workup for CD (ileocolonoscopy and cross-sectional imaging), who underwent SBCE for suspected CD. Demographics, biomarkers, and the Lewis Score (LS) were recorded and analyzed. An LS ≥ 135 was considered a positive SBCE for diagnosing CD. Results: Ninety-one patients were included: 65 (71.4%) males; median age: 37 (29–51) years; cPD duration: 25.1 (12.5–66.1) months. Positive SBCE: 24/91 (26.4%) patients. Fecal calprotectin (FC) positively correlated with LS (r = 0.81; p < 0.001). FC levels of 100 µg/g and 50 µg/g had a sensitivity of only 40% and 55% to rule out small-bowel CD, with a negative predictive value (NPV) of only 76% and 80%, respectively. Conclusions: SBCE contributed to CD diagnosis in a quarter of patients with cPD after a negative standard workup. FC levels correlated with the degree of inflammation defined by the LS. However, the NPV of FC was low, suggesting that SBCE should be considered for patients with cPD even after a negative standard workup.

(Less)
Please use this url to cite or link to this publication:
author
; ; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
algorithm, capsule endoscopy, diagnosis, fecal calprotectin, perianal Crohn’s disease
in
Diagnostics
volume
14
issue
16
article number
1733
publisher
MDPI AG
external identifiers
  • pmid:39202221
  • scopus:85202612874
ISSN
2075-4418
DOI
10.3390/diagnostics14161733
language
English
LU publication?
yes
id
182619a5-3925-45ee-8f1c-3d5765e0be84
date added to LUP
2025-01-09 13:34:44
date last changed
2025-07-11 04:53:29
@article{182619a5-3925-45ee-8f1c-3d5765e0be84,
  abstract     = {{<p>Introduction: Complicated perianal disease (cPD) may be the sole presentation of Crohn’s disease (CD). The role of small-bowel capsule endoscopy (SBCE) in the diagnostic algorithm of cPD is unclear. We aimed to evaluate the role of SBCE as a diagnostic tool, in patients with cPD, after a negative standard workup for CD. Methods: A multicenter, retrospective, cross-sectional study, in patients with cPD, and negative standard workup for CD (ileocolonoscopy and cross-sectional imaging), who underwent SBCE for suspected CD. Demographics, biomarkers, and the Lewis Score (LS) were recorded and analyzed. An LS ≥ 135 was considered a positive SBCE for diagnosing CD. Results: Ninety-one patients were included: 65 (71.4%) males; median age: 37 (29–51) years; cPD duration: 25.1 (12.5–66.1) months. Positive SBCE: 24/91 (26.4%) patients. Fecal calprotectin (FC) positively correlated with LS (r = 0.81; p &lt; 0.001). FC levels of 100 µg/g and 50 µg/g had a sensitivity of only 40% and 55% to rule out small-bowel CD, with a negative predictive value (NPV) of only 76% and 80%, respectively. Conclusions: SBCE contributed to CD diagnosis in a quarter of patients with cPD after a negative standard workup. FC levels correlated with the degree of inflammation defined by the LS. However, the NPV of FC was low, suggesting that SBCE should be considered for patients with cPD even after a negative standard workup.</p>}},
  author       = {{Avni-Biron, Irit and Toth, Ervin and Ollech, Jacob E. and Nemeth, Artur and Johansson, Gabriele Wurm and Schweinstein, Hagai and Margalit, Reuma Yehuda and Kopylov, Uri and Dotan, Iris and Yanai, Henit}},
  issn         = {{2075-4418}},
  keywords     = {{algorithm; capsule endoscopy; diagnosis; fecal calprotectin; perianal Crohn’s disease}},
  language     = {{eng}},
  number       = {{16}},
  publisher    = {{MDPI AG}},
  series       = {{Diagnostics}},
  title        = {{The Role of Small-Bowel Capsule Endoscopy in the Diagnostic Algorithm of Complicated Perianal Disease}},
  url          = {{http://dx.doi.org/10.3390/diagnostics14161733}},
  doi          = {{10.3390/diagnostics14161733}},
  volume       = {{14}},
  year         = {{2024}},
}