Pedro Boal Carvalho, MD, Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Rua dos Cutileiros, Creixomil, 4831-044 Guimarães, Portugal. pedroboalcarvalho@chaa.min-saude.pt
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
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/
Pedro Boal Carvalho, Bruno Rosa, Francisca Dias de Castro, Maria João Moreira, José Cotter
Pedro Boal Carvalho, Bruno Rosa, Francisca Dias de Castro, Maria João Moreira, José Cotter, Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, 4710-057 Braga, Portugal
Pedro Boal Carvalho, Bruno Rosa, Francisca Dias de Castro, Maria João Moreira, José Cotter, ICVS/3B’s, PT Government Associate Laboratory, 4710-057 Guimarães/Braga, Portugal
Pedro Boal Carvalho, Bruno Rosa, Francisca Dias de Castro, Maria João Moreira, José Cotter, Gastroenterology Department, Centro Hospitalar do Alto Ave, 4831-044 Guimarães, Portugal
Author contributions: Boal Carvalho P performed the study, data analysis, and a literature search and drafted the manuscript; Rosa B participated in the design of the study and reviewed the capsule endoscopies; Dias de Castro D participated in the design of the study and performed statistical analysis; Moreira MJ revised the manuscript and reviewed the capsule endoscopies; Cotter J participated in the design of the study, critically revised the manuscript and approved the final version to be submitted.
Ethics approval: The study was reviewed and approved by the Centro Hospitalar do Alto Ave Institutional Review Board.
Informed consent: All patients provided written consent to undergo total colonoscopy, small bowel capsule endoscopy and pan-enteric endoscopy with PCC2.
Conflict-of-interest: The authors have no conflict of interests regarding this manuscript.
Data sharing: No additional data are available.
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: Pedro Boal Carvalho, MD, Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Rua dos Cutileiros, Creixomil, 4831-044 Guimarães, Portugal. pedroboalcarvalho@chaa.min-saude.pt
Telephone: +351-253-540330 Fax: +351-253-513592
Received: January 11, 2015 Peer-review started: January 11, 2015 First decision: February 10, 2015 Revised: February 27, 2015 Accepted: April 17, 2015 Article in press: April 17, 2015 Published online: June 21, 2015 Processing time: 160 Days and 11.4 Hours
METHODS: 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.
RESULTS: 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.
CONCLUSION: 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.
Core tip: Our study reports for the first time the use of PillCam COLON2 Capsule (PCC2) to evaluate mucosal healing of the entire intestinal tract in small bowel plus colonic Crohn’s disease. Only 25% of our patients in corticosteroid-free clinical remission achieved mucosal healing in both the small bowel and the colon, while in 42% there was disease activity limited to either the small bowel or the colon. Endoscopic evaluation of the entire gastrointestinal tract with PCC2 was both feasible and safe. Our results highlight the limitations of clinical assessment when stratifying disease activity and emphasize the need for pan-enteric endoscopy in order to guide therapeutic adjustment.
