Pan-enteric Capsule Endoscopy to Characterize Crohn's Disease Phenotypes and Predict Clinical Outcomes in Children and Adults: The Bomiro Study

Salvatore Oliva; Silvio Veraldi; Giusy Russo; Marina Aloi; Fernando Rizzello; Paolo Gionchetti; Patrizia Alvisi; Flavio Labriola; Maurizio Vecchi; Pini Eidler; Luca Elli; Nikolas Dussias; Gian Eugenio Tontini; Carlo Calabrese

doi:10.1093/ibd/izae052

Pan-enteric Capsule Endoscopy to Characterize Crohn's Disease Phenotypes and Predict Clinical Outcomes in Children and Adults: The Bomiro Study

Inflamm Bowel Dis. 2024 Mar 26:izae052. doi: 10.1093/ibd/izae052. Online ahead of print.

Authors

Salvatore Oliva¹, Silvio Veraldi^{1

2}, Giusy Russo¹, Marina Aloi¹, Fernando Rizzello³, Paolo Gionchetti^{3

4}, Patrizia Alvisi⁵, Flavio Labriola⁵, Maurizio Vecchi^{6

7}, Pini Eidler⁷, Luca Elli⁷, Nikolas Dussias³, Gian Eugenio Tontini^{6

8}, Carlo Calabrese³

Affiliations

¹ Pediatric Gastroenterology and Liver Unit, Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy.
² Hepatogastroenterology, Nutrition, Digestive Endoscopy and Liver Transplant Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
³ IBD Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Italy.
⁴ Alma Mater Studiorum, Università di Bologna, Italy.
⁵ Pediatric Gastroenterology Unit, Maggiore Hospital, Largo Bartolo Nigrisoli, 2, 40133 Bologna, Italy.
⁶ Department of Pathophysiology and Transplantation, University of Milan, Italy.
⁷ Division of Gastroenterology and Endoscopy, Foundation IRCCS Ca' Granda Ospedale Maggiore.
⁸ Division of Gastroenterology and Endoscopy, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.

PMID: 38529957
DOI: 10.1093/ibd/izae052

Abstract

Background: Pan-enteric capsule endoscopy (PCE) provides useful information for the management of Crohn's disease (CD), especially in children. No study has evaluated the ability of PCE to characterize CD phenotypes and outcomes in children and adults.

Methods: In a prospective multicenter observational study, we recruited patients with CD >6 years from 4 centers in Italy. Patients underwent clinical, biomarker assessment and PCE. Lesions were graded using the PCE system. For each segment, the most common lesion (MCL), the most severe lesion (MSL), and the extent of involvement were defined. Disease severity, extent, and clinical outcomes were compared between children and adults. A logistic regression analysis was used to identify predictive factors for negative outcomes in both age groups.

Results: One hundred ninety-four consecutive patients (adults/children: 144/50) were evaluated for a total of 249 procedures. Children were more likely to have extensive disease, particularly in the colon. Higher MCL scores were independently associated with treatment escalation (odds ratio [OR], 4.09; 95% CI, 1.80-9.25; P = .001), while >30% disease extent was more indicative of clinical and endoscopic relapse (OR, 2.98; 1.26-7.08; P = .013). Disease extent was the only factor associated with endoscopic recurrence in children (OR, 4.50; 95% CI, 1.47-13.77; P = .008), while severe lesions in adults provided a better predictor of treatment escalation (OR, 4.31; 95% CI, 1.52-12.1; P = .006). Postexamination, PCE contributed to a change of therapy in 196/249 (79%) of the procedures.

Conclusions: PCE allowed the characterization of CD phenotypes in children and adults by assessing disease severity and extent, which are of different importance in predicting clinical outcomes in these age groups.

Keywords: intestinal inflammation; monitoring; noninvasive endoscopy; pan-enteric capsule.

Plain language summary

The study introduces the pan-enteric capsule (PCE) as an efficient tool for assessing Crohn’s disease in pediatric and adult patients, providing valuable insights into disease extent and severity, influencing treatment decisions, and improving patient care.