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P231 CECDAIic: a new score for panenteric evaluation in Crohn’s disease patients

C. Arieira*1,2,3, R. Magalhães1,2,3, F. Dias de Castro1,2,3, P. Boal Carvalho1,2,3, B. Rosa1,2,3, M. J. Moreira1,2,3, J. Cotter1,2,3

1Hospital da Senhora da Oliveira, Gastroenterology, Guimarães, Portugal, 2Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga/Guimarães, Portugal, 3ICVS/3B’s, PT Government Associate Laboratory, Braga/Guimarães, Portugal

Background

Crohn’s disease (CD) is a chronic and progressive disease characterised by inflammation affecting all the gastrointestinal tract. Panenteric capsule endoscopy has been used to assess both the small and large bowel in a single examination. The Capsule Endoscopy Crohn’s Disease Activity Index (CECDAI or Niv score) was initially devised to measure mucosal disease activity in small bowel, although in 2018 it was extended to the colon for standardisation of inflammatory activity (CECDAIic). The aim of this study was to apply the CECDAIic in a cohort of CD patients that underwent panenteric capsule to evaluate the inter-observer agreement among three observers and the correlation between this score and inflammatory parameters.

Methods

CECDAIic was calculated after dividing the bowel in 4 segments (1=proximal small bowel, 2 = distal small bowel, 3 = right colon, 4 = left colon) and according to the formula defined by the authors (A1 xB1+C1)+(A2xB2+C2)+(A3xB3+C3)+(A4xB4+C4), where A indicates inflammation; B extent of disease, and C presence of strictures. The videos were read and scored by the three independent and experienced operators, blinded to the results of the standard workup. Statistical analysis was performed with SPSS®, using Kendall’s coefficient to evaluate the interobserver agreement. Spearman correlation (r’s) was used to access the correlation between the score and inflammatory biomarkers.

Results

Included 22 patients, 59.1% (n = 13) male gender with median age 28.0 (17–54) years. In 3 patients (13.6%) the capsule was not exteriorised within the battery time. The median CECDAIic score was 9.17 (0–37). The overall CECDAIic score Kendall coefficient was 0.94, demonstrating a statistically significant (p < 0.001) excellent agreement between the three observers. In addition, we verified a high concordance between the observers for all the parameters of CECDAIic score analysed with Kendall’s coefficient of concordance (A1=0.91; B1=0.95; C1=1; A2=0.91; B2=0.91; C2 = 0.87; A3 = 0.84; B3 = 0.80; C3 = 1; A4 = 0.94; B4 = 0.88; C4 = 1; p < 0.001). We found a very good correlation between CECDAIic and Calprotectin (r’s = 0.82; p = 0.012) and a moderate correlation with C-reactive Protein (r’s = 0.50; p = 0.019).

Conclusion

CECDAIic is a new score with excellent inter-observer agreement and with a strong correlation with calprotectin. These characteristics, associated with its ease of application, may enable CECDAlic to become the tool of choice when reviewing panenteric capsule endoscopy, to more accurately and objectively assess CD inflammatory activity.