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©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jan 16, 2017; 9(1): 34-40
Published online Jan 16, 2017. doi: 10.4253/wjge.v9.i1.34
Essential role of small bowel capsule endoscopy in reclassification of colonic inflammatory bowel disease type unclassified
Sara Monteiro, Francisca Dias de Castro, Pedro Boal Carvalho, Bruno Rosa, Maria João Moreira, Rolando Pinho, Miguel Mascarenhas Saraiva, José Cotter
Sara Monteiro, Francisca Dias de Castro, Pedro Boal Carvalho, Bruno Rosa, Maria João Moreira, José Cotter, Department of Gastroenterology, Hospital da Senhora da Oliveira-Guimarães, Rua dos Cutileiros, Creixomil, 4835-044 Guimarães, Portugal
Rolando Pinho, Miguel Mascarenhas Saraiva, ManopH - Endoscopy and Digestive Motility Laboratory, 4000-432 Porto, Portugal
Rolando Pinho, Miguel Mascarenhas Saraiva, Portugal and CUF Institute, 4460-188 Matosinhos, Portugal
José Cotter, School of Medicine, University of Minho, 4710-057 Braga, Portugal
José Cotter, ICVS/3B’s, PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal
Author contributions: Monteiro S performed the study, statistical analysis, literature search and drafted the manuscript; Dias de Castro F and Boal Carvalho P participated in the design of the study and reviewed the capsule endoscopies; Rosa B, Moreira MJ, Pinho R and Mascarenhas Saraiva M participated in the design of the study, reviewed the capsule endoscopies and revised the manuscript; Cotter J participated in the design of the study and critically revised the manuscript and approved the final version to be submitted.
Institutional review board statement: This retrospective study was performed without direct contact with either patients or providers and no individual patient information was revealed. Therefore this study was not previously reviewed by the Local Ethics Committee.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to procedure by written consent.
Conflict-of-interest statement: The authors declare that there is no conflict of interests regarding the publication of this paper.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at sara.s.o.monteiro@gmail.com. Consent was not obtained but the presented data are anonymized and risk of identification is low.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sara Monteiro, MD, Department of Gastroenterology, Hospital da Senhora da Oliveira-Guimarães, Rua dos Cutileiros, Creixomil, 4835-044 Guimarães, Portugal. sara.s.o.monteiro@gmail.com
Telephone: +351-253-540330 Fax: +351-253-513592
Received: July 11, 2016
Peer-review started: July 13, 2016
First decision: August 29, 2016
Revised: October 6, 2016
Accepted: November 1, 2016
Article in press: November 3, 2016
Published online: January 16, 2017
AIM
To evaluate the role of small bowel capsule endoscopy (SBCE) on the reclassification of colonic inflammatory bowel disease type unclassified (IBDU).
METHODS
We performed a multicenter, retrospective study including patients with IBDU undergoing SBCE, between 2002 and 2014. SBCE studies were reviewed and the inflammatory activity was evaluated by determining the Lewis score (LS). Inflammatory activity was considered significant and consistent with Crohn’s disease (CD) when the LS ≥ 135. The definitive diagnosis during follow-up (minimum 12 mo following SBCE) was based on the combination of clinical, analytical, imaging, endoscopic and histological elements.
RESULTS
Thirty-six patients were included, 21 females (58%) with mean age at diagnosis of 33 ± 13 (15-64) years. The mean follow-up time after the SBCE was 52 ± 41 (12-156) mo. The SBCE revealed findings consistent with significant inflammatory activity in the small bowel (LS ≥ 135) in 9 patients (25%); in all of them the diagnosis of CD was confirmed during follow-up. In 27 patients (75%), the SBCE revealed no significant inflammatory activity (LS < 135); among these patients, the diagnosis of Ulcerative Colitis (UC) was established in 16 cases (59.3%), CD in 1 case (3.7%) and 10 patients (37%) maintained a diagnosis of IBDU during follow-up. A LS ≥ 135 at SBCE had a sensitivity = 90%, specificity = 100%, positive predictive value = 100% and negative predictive value = 94% for the diagnosis of CD.
CONCLUSION
SBCE proved to be fundamental in the reclassification of patients with IBDU. Absence of significant inflammatory activity in the small intestine allowed exclusion of CD in 94% of cases.
Core tip: This is a retrospective study to evaluate the role of small bowel capsule endoscopy (SBCE) on the reclassification of colonic inflammatory bowel disease type unclassified (IBDU). The SBCE revealed findings consistent with significant inflammatory activity in the small bowel, Lewis score (LS) ≥ 135, in 9 patients (25%); in all of them the diagnosis of Crohn’s disease (CD) was confirmed during follow-up. In 27 patients (75%) without significant inflammatory activity (LS < 135), the diagnosis of ulcerative colitis was established in 16 cases (59.3%), CD in 1 case (3.7%) and 10 patients (37%) maintained a diagnosis of IBDU during follow-up.
