Early Crohn's disease detection with capsule endoscopy improve long-term prognosis, finds study

A recent study by Yuya Ogino and colleagues created a scoring model for early Crohn's disease (CD) diagnosis based on results from small bowel capsule endoscopy (SBCE), which may help improve CD's long-term prognosis. The findings of this study were published in the Journal of Gastroenterology.

A minimally invasive technique called small bowel capsule endoscopy is utilized to see inflammatory alterations in the Crohn's disease small intestinal mucosa. The therapeutic utility of SBCE in CD has been highlighted in a number of professional guidelines. Currently, 2 grading methods are used to evaluate small bowel CD lesions found by SBCE: the Capsule Endoscopy Crohn's Disease Activity Index (CECDAI) and the Lewis Score (LS).

Although a number of studies have looked at the relationship between these 2 scoring systems, CD can present with a broad range of diseases, such as inflammation and stenosis, therefore it is hard to adequately identify the pathology using these scores alone. Using the results of the SBCE, this study created a scoring model for CD early diagnosis.

A total of 110 individuals with small intestinal mucosal lesions had their clinical and SBCE data gathered which was then randomly assigned them to derivation and validation groups. The accepted model was identified after variables were chosen for scoring models using univariate analysis. Each variable's score was determined by the odds ratio derived from multivariate analysis, and receiver operating characteristic analysis was used to look at the cut-off value for the CD diagnosis. 

The model with the best fit (odds ratios of 4.97, 7.56, and 5.34, respectively) included age (≤ 30 vs. ≥ 31), linear degradation, and circumferential alignment. 4 points were assigned to the linear erosion score, four to the circumferential alignment, and three to the age of less than 30 years.

The scoring model's sensitivity, specificity, positive predictive value, and negative predictive value for diagnosing CD were 85.4%, 80.0%, 83.7%, and 82.1%, respectively, when the cut-off value was set at 7. Like the derivation cohort, the validation cohort showed an area under the curve of 0.93.

Overall, the advantages of optimizing therapy for Crohn's disease in remission using video capsule endoscopy (VCE) were confirmed by this investigation. The flare incidence was 25% for high-risk patients with a Lewis inflammatory score of ≥350 in the treat-to-target group and 70% for those receiving conventional therapy.

Source:

Ogino, Y., Sadashima, K., Yoshida, Y., Takedomi, H., Tsuruoka, N., Sakata, Y., Takamori, A., Hisamatsu, T., Matsumoto, T., & Esaki, M. (2025). Development of a capsule endoscopy scoring system for the early diagnosis of small bowel Crohn’s disease. Journal of Gastroenterology. https://doi.org/10.1007/s00535-025-02235-x