CECDAIic – a new useful tool in pan-intestinal evaluation of Crohn’s disease patients in the era of mucosal healing

Abstract

Background: Pan-intestinal capsule endoscopy (Pan-CE) has been used to assess both the small and large bowel inflammation in Crohn’s disease (CD) patients in a single examination. The capsule endoscopy Crohn’s disease activity index (CECDAI) was initially developed to measure mucosal disease activity in the small bowel, although in 2018, it was extended to the colon for standardization of inflammatory activity (CECDAIic). The aim of this study was to apply the CECDAIic in a cohort of CD patients that underwent Pan-CE to evaluate the inter-observer agreement and the correlation between this score and inflammatory parameters.

Methods: The videos were read and scored using the CECDAIic by three independent experienced operators, blinded to the results of the standard workup. Statistical analysis was performed with SPSS^®, using Kendall’s coefficient to evaluate the inter-observer agreement. Spearman correlation (r_s) was used to access the correlation between the score and inflammatory biomarkers.

Results: Included 22 patients, 59.1% males with mean age of 30.7 ± 11.1 years. The median CECDAIic score was 9.17 (0–37). The overall CECDAIic score Kendall coefficient was 0.94, demonstrating a statistically significant (p < .001) and excellent agreement between the three observers. In addition, we found a very good correlation between CECDAIic and calprotectin (r_s = 0.82; p = .012) and a moderate correlation with C-reactive protein (CRP, r_s = 0.50; p = .019).

Conclusions: CECDAIic is a new score with excellent inter-observer agreement and strong correlation with calprotectin levels.

Keywords:

• Capsule endoscopy
• Crohn’s disease

Disclosure statement

Rosa B. has consulting services agreement with Medtronic^®. Other authors have no conflict of interest to declare.

Author contributions

Arieira C. and Dias de Castro F. designed the study, interpreted the data and drafted the manuscript. Arieira C., Magalhães R. and Boal Carvalho P. reviewed the panenteric capsules and participated in the acquisition of data and performed the statistical analysis. Dias de Castro F., Boal Carvalho P., Rosa B. and Moreira M.J. critically revised the manuscript. Cotter J. critically revised and approved the final version of the manuscript.