Copyright
©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
Evaluating mucosal healing using colon capsule endoscopy predicts outcome in patients with ulcerative colitis in clinical remission
Ryosuke Takano, Satoshi Osawa, Takahiro Uotani, Shinya Tani, Natsuki Ishida, Satoshi Tamura, Mihoko Yamade, Moriya Iwaizumi, Yasushi Hamaya, Takahisa Furuta, Hiroaki Miyajima, Ken Sugimoto
Ryosuke Takano, Takahiro Uotani, Natsuki Ishida, Satoshi Tamura, Mihoko Yamade, Yasushi Hamaya, Hiroaki Miyajima, Ken Sugimoto, First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
Satoshi Osawa, Shinya Tani, Department of Endoscopic and Photodynamic Medicine, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
Moriya Iwaizumi, Department of Laboratory Medicine, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
Takahisa Furuta, Center for Clinical Research, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
Author contributions: Takano R and Osawa S contributed to the study concept and design, analysis and interpretation of data and draughting of the manuscript; Uotani T, Tani S, Ishida N, Tamura S and Hamaya Y contributed to patient management, acquisition of data of CCE-2; Yamade M and Iwaizumi M contributed to analysis and interpretation of data; Furuta T and Miyajima H were involved in study supervision; Sugimoto K and Osawa S critically revised the manuscript for important intellectual content; All authors approved the final manuscript version prior to submission.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Hamamatsu University School of Medicine.
Clinical trial registration statement: This study is registered at UMIN clinical trial register system. The registration number is UMIN000030539.
Informed consent statement: Written informed consent for participation in the study was obtained from all patients.
Conflict-of-interest statement: The authors declare no conflicts of interest associated with this manuscript.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
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: Satoshi Osawa, MD, PhD, Assistant Professor, Department of Endoscopic and Photodynamic Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu 431-3192, Japan. sososawa@hama-med.ac.jp
Telephone: +81-53-4352261 Fax: +81-53-4349447
Received: August 24, 2018
Peer-review started: August 24, 2018
First decision: October 11, 2018
Revised: October 28, 2018
Accepted: November 7, 2018
Article in press: November 7, 2018
Published online: December 6, 2018
ARTICLE HIGHLIGHTS
Research background
Mucosal healing is a newly established therapeutic goal in ulcerative colitis (UC). The accuracy of the second generation of colon capsule endoscopy (CCE-2) for assessment of mucosal inflammation in UC appears to be comparable with that of colonoscopy (CS). It remains unclear which UC patients may benefit from the use of CCE-2, and whether evaluating endoscopic activity using CCE-2 is able to predict outcome. Further, a standard preparation regimen validated for UC patients in clinical remission has not been established.
Research motivation
Conventional CS has several limitations, such as adverse events and low patient compliance. To clarify the usefulness of less-invasive CCE-2 would provide a new option in clinical practice in UC patients.
Research objectives
To assess the feasibility of CCE-2 with a novel reduced-volume regimen in patients with UC in clinical remission, and to examine whether evaluation of endoscopic activity by CCE-2 is able to predict outcome.
Research methods
The study was conducted as single-center, prospective setting. A total of 30 consecutive patients were enrolled. CCE-2 performance was evaluated, and acceptability was assessed using a questionnaire survey. Endoscopic activity was assessed according to both Mayo endoscopic subscore (MES) and Ulcerative Colitis Endoscopic Index of Severity (UCEIS).
Research results
The rate of total colon observation was 93.3% and the proportion of “excellent” plus “good” cleansing level was 73.3% with the reduced-volume regimen. The relapse-free survival rate was significantly correlated with MES and UCEIS, whereas it was not correlated with clinical activity index. A questionnaire survey revealed an overall acceptability of CCE-2.
Research conclusions
CCE-2 was acceptable for UC patients in clinical remission. Evaluating mucosal healing using CCE-2 was able to predict outcome.
Research perspectives
Despite the small sample size, this study certainly suggested the usefulness of CCE-2 in UC patients in clinical remission. CCE-2 could serve as an alternative modality to CS for follow up of UC. Further extensive study with a larger sample size is expected to be conducted to spread this novel modality widely.
