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Diagnostic accuracy of multimodal noninvasive follow-up for pediatric ulcerative colitis: A single-center prospective
Vasiliki Spyropoulou1, Giusy Russo2, Eleonora Dei Rossi2
1Division of Pediatric Gastroenterology and Nutrition, University Children's Hospital Zurich, Zurich, Switzerland.
Insights
A new noninvasive approach combining fecal calprotectin, ultrasonography, and capsule endoscopy shows high accuracy for diagnosing pediatric ulcerative colitis. This method is better tolerated than traditional colonoscopy, offering a promising alternative for children.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Diagnostic Imaging and Endoscopy
Background:
- Ulcerative colitis (UC) diagnosis in children often requires invasive and uncomfortable ileocolonoscopy.
- There is a need for accurate, well-tolerated diagnostic methods for pediatric UC management.
Purpose of the Study:
- To evaluate the diagnostic accuracy and tolerability of a noninvasive approach for pediatric UC.
- To compare a combination of fecal calprotectin (FCP), colonic ultrasonography (US), and colon capsule endoscopy (CCE) against standard ileocolonoscopy.
Main Methods:
- Pediatric patients with UC underwent FCP and US, followed by CCE and ileocolonoscopy.
- All procedures were performed by blinded operators to ensure unbiased assessment.
- Diagnostic accuracy, including sensitivity, specificity, PPV, and NPV, was compared for individual tests and their combination.
Main Results:
- The combined noninvasive approach (FCP, US, CCE) demonstrated 95% sensitivity and 100% specificity.
- Colon capsule endoscopy (CCE) alone showed 95% sensitivity and 100% specificity.
- The noninvasive methods were significantly better tolerated than ileocolonoscopy (p < 0.05), with no serious adverse events.
Conclusions:
- The noninvasive combination of FCP, US, and CCE offers high diagnostic accuracy for pediatric UC.
- This noninvasive strategy is more tolerable for children compared to standard ileocolonoscopy.
- Further multicenter studies are warranted to confirm these findings and assess reproducibility.
Objectives:
Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) often requiring endoscopic evaluations, which can be uncomfortable and costly, especially for children. This study aimed to evaluate the diagnostic accuracy of a noninvasive approach combining fecal calprotectin (FCP), colonic ultrasonography (US), and colon capsule endoscopy (CCE) compared with standard ileocolonoscopy in pediatric UC.
Methods:
UC children were enrolled and underwent FCP and US on Day 0, followed by CCE on Day 1 and ileocolonoscopy on Day 2. All procedures were performed by operators who were blinded to the patient's clinical history and all test results. The accuracy for disease activity and extension of each technique and their combination was assessed and compared. Tolerability and safety were also evaluated.
Results:
Thirty-two patients were enrolled (15 males, mean age 13.2 ± 3.2 years). CCE showed a sensitivity of 95% and specificity of 100% in detecting colonic inflammation, with positive predictive value (PPV) and negative predictive value (NPV) of 100% and 92%, respectively. US demonstrated a sensitivity of 85% and specificity of 92%, with PPV and NPV of 94% and 79%. The combination of FCP, US, and CCE achieved 95% sensitivity and 100% specificity, with PPV of 100% and NPV of 92%. The noninvasive approach was better tolerated than colonoscopy (p < 0.05), and no serious adverse events were reported.
Conclusion:
The noninvasive approach combining fecal calprotectin (FCP), ultrasonography, and colon capsule endoscopy demonstrated high diagnostic accuracy and better tolerability compared with standard ileocolonoscopy in pediatric ulcerative colitis follow-up. Further multicenter studies are needed to confirm these findings and evaluate the reproducibility of this noninvasive approach.
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