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

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 results of a recent study.

“Monitoring Crohn’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,” wrote Shomron Ben-Horin, MD, of Sheba Medical Center, Israel, and colleagues in Lancet Gastroenterology & Hepatology. “The present study shows VCE to be a safe, acceptable, and accurate tool for monitoring small bowel Crohn’s disease and to predict future disease course.”

According to the study, the best strategy for predicting disease course in patients with Crohn’s disease is not yet established. This observational cohort study tested several monitoring strategies in 69 patients aged 18 or older with quiescent Crohn’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<.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.

“Protocols incorporating VCE could expand the scope of available methods for monitoring disease activity and guiding treat-to-target strategies in patients with Crohn’s disease involving the small bowel,” 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’s disease flare: a prospective cohort study. Lancet Gastroenterol Hepatol. 2019;doi:10.1016/S2468-1253(19)30088-3.