A Novel Capsule Endoscopic Score for Crohn's Disease

Area of Science:

• Gastroenterology
• Endoscopy
• Inflammatory Bowel Disease

Background:

• Current small bowel capsule endoscopy (SBCE) scoring systems for Crohn's disease (CD) include the Lewis Score (LS) and Capsule Endoscopy Crohn's Disease Activity Index (CECDAI).
• There is a need for a refined scoring system to specifically evaluate small bowel CD, particularly mucosal inflammation.

Purpose of the Study:

• To introduce and validate a novel SBCE scoring system for small bowel CD, termed Crohn's Disease Activity in Capsule Endoscopy (CDACE).
• To assess the correlation of CDACE with existing CD scoring systems (LS, CECDAI, CDAI) and C-reactive protein (CRP).
• To evaluate the inter-rater reliability of the CDACE scoring system.

Main Methods:

• A cross-sectional study involving 108 CD patients and 196 SBCEs.
• Scoring of small bowel lesions using the new CDACE system, which considers inflammation location, range, and stenosis (0-1643).
• Analysis of correlations between CDACE, LS, CECDAI, CDAI, and CRP, with inter-rater reliability assessed via intraclass correlation coefficient (ICC).

Main Results:

• CDACE demonstrated significant correlations with LS (ρ=0.737) and CECDAI (ρ=0.915), both P < 0.0001.
• Correlations were also observed between CDACE and CDAI (ρ=0.36) and CRP (ρ=0.23).
• The ICC (2.1) for CDACE was 0.829, indicating strong inter-rater agreement.

Conclusions:

• The CDACE scoring system is a potentially valuable tool for SBCE in managing small bowel Crohn's disease.
• CDACE effectively captures the extent and distribution of mucosal inflammation and stenosis in the small bowel.