PillCam COLON 2 in Crohn's disease: A new concept of pan-enteric mucosal healing assessment

• Published in: World journal of gastroenterology : WJG Vol. 21; no. 23; pp. 7233 - 7241
• Main Authors: Boal Carvalho, Pedro, Rosa, Bruno, Dias de Castro, Francisca, Moreira, Maria João, Cotter, José
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Inc 21.06.2015
• Subjects: Adolescent; Adult; Capsule Endoscopes; Capsule Endoscopy - instrumentation; Colon - drug effects; Colon - pathology; Crohn Disease - drug therapy; Crohn Disease - pathology; Female; Humans; Immunosuppressive Agents - therapeutic use; Intestinal Mucosa - drug effects; Intestinal Mucosa - pathology; Intestine, Small - drug effects; Intestine, Small - pathology; Male; Middle Aged; Predictive Value of Tests; Remission Induction; Retrospective Studies; Retrospective Study; Time Factors; Treatment Outcome; Wound Healing - drug effects; Young Adult; Inflammatory bowel disease; Mucosal healing; Capsule endoscopy; Small bowel diseases; Crohn’s disease
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v21.i23.7233

To evaluate mucosal healing in patients with small bowel plus colonic Crohn's disease (CD) with a single non-invasive examination, by using PillCam COLON 2 (PCC2). Patients with non-stricturing nonpenetrating small bowel plus colonic CD in sustained corticosteroid-free remission were included. At diagnosis, patients had undergone ileocolonoscopy to identify active CD lesions, such as ulcers and erosions, and small bowel capsule endoscopy to assess the Lewis Score (LS). After ≥ 1 year of follow-up, patients underwent entire gastrointestinal tract evaluation with PCC2. The primary endpoint was assessment of CD mucosal healing, defined as no active colonic CD lesions and LS < 135. Twelve patients were included (7 male; mean age: 32 years), and mean follow-up was 38 mo. The majority of patients (83.3%) received immunosuppressive therapy. Three patients (25%) achieved mucosal healing in both the small bowel and the colon, while disease activity was limited to either the small bowel or the colon in 5 patients (42%). It was possible to observe the entire gastrointestinal tract in 10 of the 12 patients (83%) who underwent PCC2. Only three patients in sustained corticosteroid-free clinical remission achieved mucosal healing in both the small bowel and the colon, highlighting the limitations of clinical assessment when stratifying disease activity, and the need for pan-enteric endoscopy to guide therapeutic modification.