Published online Jun 21, 2015. doi: 10.3748/wjg.v21.i23.7233
Peer-review started: January 11, 2015
First decision: February 10, 2015
Revised: February 27, 2015
Accepted: April 17, 2015
Article in press: April 17, 2015
Published online: June 21, 2015
Processing time: 160 Days and 11.4 Hours
AIM: To evaluate mucosal healing in patients with small bowel plus colonic Crohn’s disease (CD) with a single non-invasive examination, by using PillCam COLON 2© (PCC2).
METHODS: Patients with non-stricturing nonpenetrating small bowel plus colonic CD in sustained corticosteroid-free remission were included. At diagnosis, patients had undergone ileocolonoscopy to identify active CD lesions, such as ulcers and erosions, and small bowel capsule endoscopy to assess the Lewis Score (LS). After ≥ 1 year of follow-up, patients underwent entire gastrointestinal tract evaluation with PCC2. The primary endpoint was assessment of CD mucosal healing, defined as no active colonic CD lesions and LS < 135.
RESULTS: Twelve patients were included (7 male; mean age: 32 years), and mean follow-up was 38 mo. The majority of patients (83.3%) received immunosuppressive therapy. Three patients (25%) achieved mucosal healing in both the small bowel and the colon, while disease activity was limited to either the small bowel or the colon in 5 patients (42%). It was possible to observe the entire gastrointestinal tract in 10 of the 12 patients (83%) who underwent PCC2.
CONCLUSION: Only three patients in sustained corticosteroid-free clinical remission achieved mucosal healing in both the small bowel and the colon, highlighting the limitations of clinical assessment when stratifying disease activity, and the need for pan-enteric endoscopy to guide therapeutic modification.
Core tip: Our study reports for the first time the use of PillCam COLON2 Capsule (PCC2) to evaluate mucosal healing of the entire intestinal tract in small bowel plus colonic Crohn’s disease. Only 25% of our patients in corticosteroid-free clinical remission achieved mucosal healing in both the small bowel and the colon, while in 42% there was disease activity limited to either the small bowel or the colon. Endoscopic evaluation of the entire gastrointestinal tract with PCC2 was both feasible and safe. Our results highlight the limitations of clinical assessment when stratifying disease activity and emphasize the need for pan-enteric endoscopy in order to guide therapeutic adjustment.