Assessment of Treatment Response in Known Crohn's Disease-A Prospective Blinded Study Comparing the Diagnostic Accuracy of Intestinal Ultrasound, Magnetic Resonance Enterocolonography, Panenteric Capsule Endoscopy, and Fecal Calprotectin.
Jacob Broder Brodersen, Søren Rafael Rafaelsen, Mie Agerbæk Juel, Torben Knudsen, Jens Kjeldsen, Michael Dam Jensen
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引用次数: 0
Abstract
Background: Minimally invasive modalities may replace ileocolonoscopy (IC) in the follow-up of Crohn's disease (CD). The aim of this study was to evaluate intestinal ultrasound (IUS), magnetic resonance enterocolonography (MREC), panenteric capsule endoscopy (PCE), and fecal calprotectin (FC) for determining response to medical treatment in patients with ileocolonic CD.
Methods: This prospective, blinded, multicenter study included patients with endoscopically active CD. Patients were scheduled for IC, MREC, IUS, PCE, and FC before and 12 weeks after treatment with corticosteroids or biological therapy. A ≥50% reduction of the Simple Endoscopic Score for Crohn's Disease (SES-CD) with IC defined treatment response.
Results: Fifty patients completed the pre- and posttreatment evaluation with IC, and endoscopic response was achieved in 25 (50.0%). PCE was omitted in 12 (24.0%) patients because of stricturing CD. All activity scores decreased in patients achieving endoscopic response: The Simple Ultrasound Score for Crohn's Disease 2.2 vs 6.1 (P < .001), Magnetic Resonance Index of Activity 29.0 vs 37.1 (P = .05), SES-CD with PCE 3.1 vs 12.8 (P < .001), and FC 115.3 vs 1339.9 mg/kg (P < .001). The sensitivity and specificity of IUS, MREC, PCE, and FC were 80.0% (95% CI, 56.3-94.3)/77.8% (95% CI, 52.4-93.6), 65.2% (95% CI, 42.7-83.6)/87.0% (95% CI, 66.4-97.2), 87.5% (95% CI, 61.7-98.4)/86.7% (95% CI, 59.5-98.3), and 90.0% (95% CI, 68.3-98.8)/86.4% (95% CI, 65.1-97.1), respectively.
Conclusions: IUS and FC are equally effective for determining treatment response in patients with active CD. PCE is limited by the occurrence of strictures in this group of patients.
背景：在克罗恩病（CD）的随访中，微创方式可能会取代回肠结肠镜检查（IC）。本研究旨在评估肠道超声（IUS）、磁共振肠结肠造影（MREC）、肠道胶囊内镜（PCE）和粪便钙蛋白（FC）在确定回结肠 CD 患者对药物治疗的反应方面的作用：这项前瞻性、盲法、多中心研究纳入了内镜下活动性 CD 患者。患者在皮质类固醇或生物疗法治疗前和治疗后12周接受IC、MREC、IUS、PCE和FC检查。内镜下克罗恩病简易评分（SES-CD）与IC评分下降≥50%即为治疗反应：结果：50 名患者完成了 IC 治疗前后的评估，其中 25 人（50.0%）获得了内镜反应。有 12 例（24.0%）患者因内镜下 CD 治疗严格而省略了 PCE。在获得内镜反应的患者中，所有活动评分均有所下降：克罗恩病简易超声评分 2.2 vs 6.1（P 结论：IUS 和 FC 对克罗恩病同样有效：IUS 和 FC 对于确定活动性 CD 患者的治疗反应同样有效。PCE 受限于这类患者的狭窄发生率。
期刊介绍：
Inflammatory Bowel Diseases® supports the mission of the Crohn''s & Colitis Foundation by bringing the most impactful and cutting edge clinical topics and research findings related to inflammatory bowel diseases to clinicians and researchers working in IBD and related fields. The Journal is committed to publishing on innovative topics that influence the future of clinical care, treatment, and research.
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