Development and validation of a scoring index to predict the presence of lesions in capsule endoscopy in patients with suspected Crohn's disease of the small bowel: a Spanish multicenter study
Egea-Valenzuela J (1), González Suárez B (2), Sierra Bernal C (3), Juanmartiñena Fernández JF (4), Luján-Sanchís M (5), San Juan Acosta M (6), Martínez Andrés B (7), Pons Beltrán V (8), Sastre Lozano V (9), Carretero Ribón C (10), de Vera Almenar F (11), Sánchez Cuenca J (12), Alberca de Las Parras F (1), Rodríguez de Miguel C (2), Valle Muñoz J (3), Férnandez-Urién Sainz I (4), Torres González C (5), Borque Barrera P (6), Pérez-Cuadrado Robles E (7), Alonso Lázaro N (8), Martínez García P (9), Prieto de Frías C (10), Carballo Álvarez F (1).
(1) Department of Digestive Diseases, University Clinical Hospital Virgen de la Arrixaca.
(2) Department of Digestive Diseases, Clinic Hospital, Barcelona.
(3) Department of Digestive Diseases, Hospital Complex, Toledo.
(4) Department of Digestive Diseases, Hospital Complex.
(5) Department of Digestive Diseases, Univesity General Hospital.
(6) Department of Digestive Diseases, University Hospital Nuestra Señora de Candelaria, Tenerife.
(7) Department of Digestive Diseases, University Hospital Morales Meseguer, Murcia.
(8) Group of research in Digestive Endoscopy, University and Politechnic Hospital La Fe, Valencia.
(9) Department of Digestive Diseases, University General Hospital Santa Lucia, Cartagena.
(10) Department of Digestive Diseases, University Clinics of Navarra, Pamplona.
(11) Department of Digestive Diseases, University General Hospital, Elda.
(12) Department of Digestive Diseases, University Hospital San Juan, Alicante, Spain.
Capsule endoscopy (CE) is the first-line investigation in cases of suspected Crohn's disease (CD) of the small bowel, but the factors associated with a higher diagnostic yield remain unclear.
Our aim is to develop and validate a scoring index to assess the risk of the patients in this setting on the basis of biomarkers.
PATIENTS AND METHODS:
Data on fecal calprotectin, C-reactive protein, and other biomarkers from a population of 124 patients with suspected CD of the small bowel studied by CE and included in a PhD study were used to build a scoring index. This was first used on this population (internal validation process) and after that on a different set of patients from a multicenter study (external validation process).
An index was designed in which every biomarker is assigned a score. Three risk groups have been established (low, intermediate, and high). In the internal validation analysis (124 individuals), patients had a 10, 46.5, and 81% probability of showing inflammatory lesions in CE in the low-risk, intermediate-risk, and high-risk groups, respectively. In the external validation analysis, including 410 patients from 12 Spanish hospitals, this probability was 15.8, 49.7, and 80.6% for the low-risk, intermediate-risk, and high-risk groups, respectively.
Results from the internal validation process show that the scoring index is coherent, and results from the external validation process confirm its reliability. This index can be a useful tool for selecting patients before CE studies in cases of suspected CD of the small bowel.
CITA DEL ARTÍCULO Eur J Gastroenterol Hepatol. 2018 May;30(5):499-505. doi: 10.1097/MEG.0000000000001083