Changes in Endoscopic Activity and Classification of Lesions With Panenteric Capsule Endoscopy in Patients Treated for Crohn's Disease-A Prospective Blinded Comparison With Ileocolonoscopy, Fecal Calprotectin, and C-Reactive Protein

Background and Aims: Panenteric capsule endoscopy (PCE) is a minimally invasive modality that may replace ileocolonoscopy (IC) in selected patients with Crohn's disease (CD). This study aimed to evaluate the dynamics of repeated assessment with PCE in patients receiving medical treatment for ileocolonic CD. Methods: This prospective, blinded, multicenter study included patients with endoscopically active CD. Patients were scheduled for IC, PCE, fecal calprotectin, and C-reactive protein before and 12 weeks after treatment with corticosteroids or biological therapy. The endoscopic disease activity was assessed with the Simple Endoscopic Score for Crohn's Disease (SES-CD). Results: Thirty-one patients entered the study, and PCE visualized 148 (95.5%) and 128 (82.6%) ileocolonic bowel segments before and after medical treatment, respectively. The median SES-CD decreased from 14 (interquartile range [IQR] 8-17) to 5 (IQR 0-14) (p < 0.001) and 14 (IQR 10-17) to 6 (IQR 3-12) (p < 0.001) with IC and PCE, respectively. The repeated measures correlation between PCE and IC was very strong (r = 0.77, p < 0.001), strong compared to fecal calprotectin (r = 0.42, p = 0.003), and moderate compared to C-reactive protein (r = 0.36, p = 0.005). The mean scores for ulcer size, ulcerated surface, and affected surface were comparable between PCE and IC both before and after treatment. PCE had a sensitivity and specificity of 80.6% (95% confidence interval [95% CI] 62.5-92.5) and 93.8% (95% CI 79.2-99.2), respectively, for ulcer healing compared to IC. Conclusions: PCE is responsive in patients treated for CD and may serve as a minimally invasive alternative to IC in selected patients.