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Monitoring patients with quiescent Crohn&rsquo;s disease with video capsule endoscopy (VCE) predicted both short- and long-term risk of disease exacerbation, according to the results of a recent study.&ldquo;Monitoring Crohn&rsquo;s disease that involves the small bowel is challenging because of partial inaccessibility of the small bowel to standard ileocolonoscopy and because of low patient acceptance of this invasive procedure,&rdquo; wrote Shomron Ben-Horin, MD, of Sheba Medical Center, Israel, and colleagues in Lancet Gastroenterology &amp; Hepatology. &ldquo;The present study shows VCE to be a safe, acceptable, and accurate tool for monitoring small bowel Crohn&rsquo;s disease and to predict future disease course.&rdquo;According to the study, the best strategy for predicting disease course in patients with Crohn&rsquo;s disease is not yet established. This observational cohort study tested several monitoring strategies in 69 patients aged 18 or older with quiescent Crohn&rsquo;s disease involving the smell bowel.To monitor the disease course, patients underwent baseline MRI and patency capsule, clinical biomarker assessment every 3 months, and VCE at baseline and every 6 months for 2 years or until clinical flare or disease worsening.During the study, 28% developed a flare during the 2-year follow-up period. C-reactive protein at baseline had an area under the curve (AUC) of 0.73 for prediction of flare (P=.0013). Baseline fecal calprotectin for prediction of flare within 2 years was 0.62 (P=.17), but this improved for shorter timespans, reaching and AUC of 0.81 for flare within 3 months.VCE predicted both short- and long-term risk of flare. A baseline VCE Lewis score of 350 or more identified patients with future flare (AUC=0.79; P&lt;.0001). During follow-up, a Lewis score increase of 383 points or more from baseline predicted imminent disease exacerbation within 6 months (AUC=0.79; P=.011). VCEs had excellent safety and tolerability; none were retained.&ldquo;Protocols incorporating VCE could expand the scope of available methods for monitoring disease activity and guiding treat-to-target strategies in patients with Crohn&rsquo;s disease involving the small bowel,&rdquo; the researchers concluded.Ben-Horin S, Lahat A, Amitai MM, et al. Assessment of small bowel mucosal healing by video capsule endoscopy for the prediction of short-term and long-term risk of Crohn&rsquo;s disease flare: a prospective cohort study. Lancet Gastroenterol Hepatol. 2019;doi:10.1016/S2468-1253(19)30088-3.&nbsp;

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Video Capsule Endoscopy Predicted Short, Long-Term Risk for Crohn’s Flare

Gastroenterology

Monitoring patients with quiescent Crohn’s disease with video capsule endoscopy (VCE) predicted both short- and long-term risk of disease exacerbation, according to the ...

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