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Crohn Disease: HELP
Articles by Anastasios Koulaouzidis
Based on 13 articles published since 2008
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Between 2008 and 2019, A. Koulaouzidis wrote the following 13 articles about Crohn Disease.
 
+ Citations + Abstracts
1 Review Monitoring of small bowel Crohn's disease. 2017

Kopylov, Uri / Koulaouzidis, Anastasios / Klang, Eyal / Carter, Dan / Ben-Horin, Shomron / Eliakim, Rami. ·a Department of Gastroenterology, Sheba Medical Center, Tel Hashomer and Sackler Medical School , Tel Aviv University , Tel-Aviv , Israel. · b Centre for Liver & Digestive Disorders , The Royal Infirmary of Edinburgh , Edinburgh , UK. · c Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer and Sackler Medical School , Tel Aviv University , Tel-Aviv , Israel. ·Expert Rev Gastroenterol Hepatol · Pubmed #28737951.

ABSTRACT: INTRODUCTION: In recent years, the therapeutic paradigm in Crohn's disease has shifted from a mere symptom-oriented approach, to aiming to healing of the underlying inflammation and prevention of long-term structural complications. Such 'treat-to-target' approach may allow for a more stable disease course with less hospitalizations, lower requirement for surgery and improved quality of life. In Crohn's disease, the small bowel is affected in the majority of patients; frequently, Crohn's involves only the small bowel, which remains inaccessible to conventional ileocolonoscopic techniques. Thus, non-invasive monitoring techniques are crucial for accurate disease assessment. Areas covered: This review addresses the indications and clinical implications of non-invasive small bowel monitoring modalities (magnetic resonance enterography, intestinal ultrasound, capsule endoscopy) in the assessment and management of Crohn's disease. Expert commentary: This review addresses the limitations of the current knowledge and future areas of research, including the possible utilization of transmural healing as an imaging target and the need to establish clear quantitative target values to guide treatment by imaging findings in Crohn's disease.

2 Review Diagnostic yield of capsule endoscopy versus magnetic resonance enterography and small bowel contrast ultrasound in the evaluation of small bowel Crohn's disease: Systematic review and meta-analysis. 2017

Kopylov, Uri / Yung, Diana E / Engel, Tal / Vijayan, Sanju / Har-Noy, Ofir / Katz, Lior / Oliva, Salvatore / Avni, Tomer / Battat, Robert / Eliakim, Rami / Ben-Horin, Shomron / Koulaouzidis, Anastasios. ·Gastroenterology Department, Sheba Medical Center, Ramat-Gan, and Sackler School of Medicine, Tel-Aviv University, Israel. Electronic address: ukopylov@gmail.com. · Centre for Liver & Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom. · Gastroenterology Department, Sheba Medical Center, Ramat-Gan, and Sackler School of Medicine, Tel-Aviv University, Israel. · Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Italy. · Department of Medicine E, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, and Sackler School of Medicine, Tel-Aviv University, Israel. · McGill University Health Center, McGill University, Montreal, QC, Canada. ·Dig Liver Dis · Pubmed #28512034.

ABSTRACT: BACKGROUND AND AIMS: Capsule endoscopy (CE), magnetic resonance enterography (MRE) and small bowel (SB) intestinal contrast ultrasound (SICUS) are the modalities of choice for SB evaluation. This study aimed to compare the diagnostic yield (DY) of CE to MRE and SICUS in detection and monitoring of SB CD through meta-analysis of the available literature. METHODS: We performed a systematic literature search for trials comparing the accuracy of CE, MRE and SICUS for detection of active SB inflammation in patients with suspected and/or established CD. Only prospective studies comparing CE with another additional diagnostic modality were included in the final analysis. Pooled odds ratios (ORs) for the DY of the three modalities were calculated. RESULTS: A total of 112 studies were retrieved; following selection, 13 studies were eligible for analysis. The DY of CE for detection of active SB CD was similar to that of MRE (10 studies, 400 patients, OR 1.17; 95% CI 0.83-1.67) and SICUS (5 studies, 142 patients, OR 0.88; 95% CI 0.51-1.53). The outcomes were similar for the subgroups of suspected versus established CD and adult versus pediatric patients. CE was superior to MRE for proximal SB CD (7 studies, 251 patients, OR 2.79; 95% CI 1.2-6.48); the difference vs SICUS was not significant. CONCLUSION: CE, MRE and SICUS have similar DY for detection of SB CD in both suspected and established CD. CE is superior to MRE for detection of proximal SB disease, however the risk of capsule retention should be considered.

3 Review Fecal calprotectin for the prediction of small-bowel Crohn's disease by capsule endoscopy: a systematic review and meta-analysis. 2016

Kopylov, Uri / Yung, Diana E / Engel, Tal / Avni, Tomer / Battat, Robert / Ben-Horin, Shomron / Plevris, John N / Eliakim, Rami / Koulaouzidis, Anastasios. ·aDepartment of Gastroenterology, Sheba Medical Center, Tel Hashomer, and Sackler Medical School bDepartment of Medicine E, Rabin Medical Center, Petach Tikva and Sackler Medical School, Tel Aviv 52960, Israel cCentre for Liver & Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK dDepartment of Gastroenterology, McGill University Health Center, Montreal, Québec, Canada. ·Eur J Gastroenterol Hepatol · Pubmed #27415156.

ABSTRACT: BACKGROUND AND AIMS: Fecal calprotectin is a well-established marker of mucosal inflammation. Although the correlation of elevated calprotectin levels with colonic inflammation has been confirmed repeatedly, it is less established for the small bowel. The aim of the current study was to assess the diagnostic accuracy of calprotectin for the prediction of active small-bowel disease on capsule endoscopy by performing a diagnostic test meta-analysis. MATERIALS AND METHODS: A comprehensive search was performed using PubMed/Embase. Studies addressing patients with suspected/established Crohn's disease (CD) evaluated with calprotectin and videocapsule were included. A diagnostic meta-analysis was carried out; pooled diagnostic sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated for each cut-off. RESULTS: Seven studies (463 patients) were entered into the final analysis. The DOR was significant for all the evaluated FC cut-offs (50 μg/g: sensitivity 0.83, specificity 0.53, DOR-5.64; 100 μg/g: sensitivity 0.68, specificity 0.71, DOR-5.01; 200 μg/g: sensitivity 0.42, specificity 0.94, DOR-13.64). On sensitivity analyses, when only studies addressing suspected Crohn's or retrospective studies were included, the results did not change significantly. For studies including patients with suspected CD only, the overall accuracy for FC cut-off 50 μg/g was further increased (sensitivity 0.89, specificity 0.55, DOR-10.3), with a negative predictive value of 91.8%. SUMMARY AND CONCLUSION: Fecal calprotectin has a significant diagnostic accuracy for the detection of small-bowel CD. Our results suggest that in patients with suspected CD with calprotectin <50 μg/g, the likelihood of positive diagnosis is very low.

4 Review Quantitative measurements in capsule endoscopy. 2015

Keuchel, M / Kurniawan, N / Baltes, P / Bandorski, D / Koulaouzidis, A. ·Clinic for Internal Medicine, Bethesda Krankenhaus Bergedorf, Glindersweg 80, 21029 Hamburg, Germany. Electronic address: keuchel@bkb.info. · Clinic for Internal Medicine, Bethesda Krankenhaus Bergedorf, Glindersweg 80, 21029 Hamburg, Germany. · Kerckhoff Klinik, Bad Nauheim, Germany. · Endoscopy Unit, The Royal Infirmary of Edinburgh, UK. ·Comput Biol Med · Pubmed #26299419.

ABSTRACT: This review summarizes several approaches for quantitative measurement in capsule endoscopy. Video capsule endoscopy (VCE) typically provides wireless imaging of small bowel. Currently, a variety of quantitative measurements are implemented in commercially available hardware/software. The majority is proprietary and hence undisclosed algorithms. Measurement of amount of luminal contamination allows calculating scores from whole VCE studies. Other scores express the severity of small bowel lesions in Crohn׳s disease or the degree of villous atrophy in celiac disease. Image processing with numerous algorithms of textural and color feature extraction is further in the research focuses for automated image analysis. These tools aim to select single images with relevant lesions as blood, ulcers, polyps and tumors or to omit images showing only luminal contamination. Analysis of motility pattern, size measurement and determination of capsule localization are additional topics. Non-visual wireless capsules transmitting data acquired with specific sensors from the gastrointestinal (GI) tract are available for clinical routine. This includes pH measurement in the esophagus for the diagnosis of acid gastro-esophageal reflux. A wireless motility capsule provides GI motility analysis on the basis of pH, pressure, and temperature measurement. Electromagnetically tracking of another motility capsule allows visualization of motility. However, measurement of substances by GI capsules is of great interest but still at an early stage of development.

5 Article Capsule Endoscopy, Magnetic Resonance Enterography, and Small Bowel Ultrasound for Evaluation of Postoperative Recurrence in Crohn's Disease: Systematic Review and Meta-Analysis. 2017

Yung, Diana E / Har-Noy, Ofir / Tham, Yuen Sau / Ben-Horin, Shomron / Eliakim, Rami / Koulaouzidis, Anastasios / Kopylov, Uri. ·Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom. · Department of Gastroenterology, Sheba Medical Center, Ramat-Gan, and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel. ·Inflamm Bowel Dis · Pubmed #29272490.

ABSTRACT: Background: Anastomotic recurrence is frequent in patients with Crohn's disease (CD) following ileocecal resection. The degree of endoscopic recurrence, quantified by the Rutgeerts score (RS), is correlated with the risk of clinical and surgical recurrence. Noninvasive modalities such as capsule endoscopy (CE), magnetic resonance enterography (MRE), and intestinal ultrasound (US) may yield similar information without the need for ileocolonoscopy (IC). The aim of our meta-analysis was to evaluate the accuracy of those modalities for detection of endoscopic recurrence in postoperative CD patients. Methods: We performed a systematic literature search for studies comparing the accuracy of CE, MRE, and US with IC for detection of postoperative recurrence in CD. We calculated pooled diagnostic sensitivity, specificity, diagnostic odds ratio (DOR), and area under the curve (AUC) for each comparison. Results: A total of 135 studies were retrieved; 14 studies were eligible for analysis. For CE, the pooled sensitivity was 100% (95% CI, 91%-100%), specificity was 69% (95% CI, 52%-83%), DOR was 30.8 (95% CI, 6.9-138), and AUC was 0.94. MRE had pooled sensitivity of 97% (95% CI, 89%-100%), specificity of 84% (95% CI, 62%-96%), DOR of 129.5 (95% CI, 16.4-1024.7), and AUC of 0.98. US had pooled sensitivity of 89% (95% CI, 85%-92%), specificity of 86% (95% CI, 78%-93%), DOR of 42.3 (95% CI, 18.6-96.0), and AUC 0.93. Conclusions: CE, MRE, and US provide accurate assessment of postoperative endoscopic recurrence in CD. These modalities should gain wider use for detection of postoperative recurrence; the prognostic value of those diagnostic findings merits evaluation in further prospective studies.

6 Article Small-bowel capsule endoscopy with panoramic view: results of the first multicenter, observational study (with videos). 2017

Tontini, Gian Eugenio / Wiedbrauck, Felix / Cavallaro, Flaminia / Koulaouzidis, Anastasios / Marino, Roberta / Pastorelli, Luca / Spina, Luisa / McAlindon, Mark E / Leoni, Piera / Vitagliano, Pasquale / Cadoni, Sergio / Rondonotti, Emanuele / Vecchi, Maurizio. ·Gastroenterology & Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy. · Klinik für Gastroenterologie/GI-Onkologie, Allgemeines Krankenhaus Celle, Celle, Germany. · Centre for Liver & Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom. · Gastroenterology & Digestive Endoscopy Unit, AO Lodi, Lodi, Italy. · Gastroenterology & Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy. · Gastroenterology, Royal Hallamshire Hospital, Sheffield, United Kingdom. · Gastroenterology & Digestive Endoscopy Unit, AO di Melegnano, Milan, Italy. · Digestive Endoscopy Unit, St. Barbara Hospital, Iglesias, Carbonia-Iglesias, Italy. · Gastroenterology Unit, Valduce Hospital, Como, Italy. ·Gastrointest Endosc · Pubmed #27515129.

ABSTRACT: BACKGROUND AND AIMS: The first small-bowel video-capsule endoscopy (VCE) with 360° panoramic view has been developed recently. This new capsule has wire-free technology, 4 high-frame-rate cameras, and a long-lasting battery life. The aim of the present study was to assess the performance and safety profile of the 360° panoramic-view capsule in a large series of patients from a multicenter clinical practice setting. METHODS: Consecutive patients undergoing a 360° panoramic-view capsule procedure in 7 European Institutions between January 2011 and November 2015 were included. Both technical (ie, technical failures, completion rate) and clinical (ie, indication, findings, retention rate) data were collected by means of a structured questionnaire. VCE findings were classified according to the likelihood of explaining the reason for referral: P0, low; P1, intermediate; P2, high. RESULTS: Of the 172 patients (94 men; median age, 68 years; interquartile range, 53-75), 142 underwent VCE for obscure (32 overt, 110 occult) GI bleeding (OGIB), and 28 for suspected (17) or established (2) Crohn's disease (CD). Overall, 560 findings were detected; 252 were classified as P2. The overall diagnostic yield was 40.1%; 42.2% and 30.0% in patients with OGIB and CD, respectively. The rate of complete enteroscopy was 90.2%. All patients but one, who experienced capsule retention (1/172, 0.6%), excreted and retrieved the capsule. VCE failure occurred in 4 of 172 (2.3%) patients because of technical problems. CONCLUSIONS: This multicenter study, conducted in the clinical practice setting and based on a large consecutive series of patients, showed that the diagnostic yield and safety profile of the 360° panoramic-view capsule are similar to those of forward-view VCEs.

7 Article Use of patency capsule in patients with established Crohn's disease. 2016

Nemeth, Artur / Kopylov, Uri / Koulaouzidis, Anastasios / Wurm Johansson, Gabriele / Thorlacius, Henrik / Amre, Devendra / Eliakim, Rami / Seidman, Ernest G / Toth, Ervin. ·Department of Gastroenterology, Skåne University Hospital, Lund University, Malmö, Sweden. · Division of Gastroenterology, McGill University Health Center, Montreal, Quebec, Canada. · Endoscopy Unit, Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Scotland, United Kingdom. · Department of Surgery, Skåne University Hospital, Lund University, Malmö, Sweden. · Research Institute, Saint Justine Medical Center, Universite de Montreal, Montreal, Quebec, Canada. · Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Israel. ·Endoscopy · Pubmed #26561918.

ABSTRACT: BACKGROUND AND STUDY AIMS: Video capsule endoscopy (VCE) is invaluable in the diagnosis of small-bowel pathology. Capsule retention is a major concern in patients with Crohn's disease. The patency capsule was designed to evaluate small-bowel patency before VCE. However, the actual benefit of the patency capsule test in Crohn's disease remains unclear. The aim of this study was to evaluate the clinical impact of patency capsule use on the risk of video capsule retention in patients with established Crohn's disease. PATIENTS AND METHODS: This was a retrospective, multicenter study of patients with established Crohn's disease who underwent VCE for clinical need. The utilization strategy for the patency capsule was classified as selective (only in patients with obstructive symptoms, history of intestinal obstruction or surgery, or per treating physician's request) or nonselective (all patients with Crohn's disease). The main outcome was video capsule retention in the entire cohort and within each utilization strategy. RESULTS: A total of 406 patients who were referred for VCE were included in the study. VCE was performed in 132 /406 patients (32.5 %) without a prior patency capsule test. The patency capsule test was performed in 274 /406 patients (67.5 %) and was negative in 193 patients. Overall, VCE was performed in 343 patients and was retained in the small bowel in 8 (2.3 %). In this cohort, the risk of video capsule retention in the small bowel was 1.5 % without use of a prior patency capsule and 2.1 % after a negative patency test (P = 0.9). A total of 18 patients underwent VCE after a positive patency capsule test, with a retention rate of 11.1 % (P = 0.01). Patency capsule administration strategy (selective vs. nonselective) was not associated with the risk of video capsule retention. CONCLUSIONS: Capsule retention is a rare event in patients with established Crohn's disease undergoing VCE. The risk of video capsule retention was not reduced by the nonselective use of the patency capsule. Furthermore, VCE after a positive patency capsule test in patients with Crohn's disease was associated with a high risk of video capsule retention.

8 Article Small bowel capsule endoscopy in the management of established Crohn's disease: clinical impact, safety, and correlation with inflammatory biomarkers. 2015

Kopylov, Uri / Nemeth, Artur / Koulaouzidis, Anastasios / Makins, Richard / Wild, Gary / Afif, Waqqas / Bitton, Alain / Johansson, Gabriele Wurm / Bessissow, Talat / Eliakim, Rami / Toth, Ervin / Seidman, Ernest G. ·*Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada; †Department of Gastroenterology, Skåne University Hospital, Malmö, Lund University, Lund, Sweden; ‡Endoscopy Unit, Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom; §Department of Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust, Chetlenham, United Kingdom; and ‖Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Israel. ·Inflamm Bowel Dis · Pubmed #25517597.

ABSTRACT: BACKGROUND: Multiple studies have established the superior diagnostic accuracy of video capsule endoscopy (VCE) for the diagnosis of small bowel (SB) Crohn's disease (CD). However, data on the clinical impact of VCE in patients with established CD are scarce. The aim of this study was to examine the impact and safety of VCE on the clinical management of patients with established CD. METHODS: A retrospective, multicenter, cross-sectional study. The study cohort included consecutive patients with established SB CD who underwent VCE in 4 tertiary referral centers (1 Canada, 1 Sweden, and 2 United Kingdom) from January 2008 to October 2013. Patients were excluded if VCE was performed as a part of the initial diagnostic workup. The presence of SB mucosal inflammation was quantified using the Lewis score. Inflammatory biomarkers (C-reactive protein and fecal calprotectin) were measured and correlated with the Lewis score. RESULTS: The study included 187 patients. No SB inflammation was observed in 28.4%, mild-to-moderate inflammation in 26.6%, and moderate-to-severe inflammation in 45% of the patients (median Lewis score, 662; range, 0-6400). A change in management was recommended in 52.3% of the patients based on VCE findings. Elevated C-reactive protein, fecal calprotectin, or the combination of both were poorly correlated with significant SB inflammation. SB capsule retention occurred in 4 patients (2.1%). CONCLUSIONS: VCE in patients with established CD is safe, and the results often have a significant clinical impact. VCE should not be limited to CD patients with positive inflammatory markers because their predictive value for significant SB inflammation is poor.

9 Article Detection of the ampulla of Vater in small bowel capsule endoscopy: experience with two different systems. 2012

Koulaouzidis, Anastasios / Plevris, John N. ·Endoscopy Unit, Center for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK. akoulaouzidis@hotmail.com ·J Dig Dis · Pubmed #23134524.

ABSTRACT: OBJECTIVE: The aim of this study was to determine the detection rate of the ampulla of Vater (AoV) during small bowel capsule endoscopy (SBCE) examinations and compare the two SBCE systems used in our center. METHODS: SBCE procedures performed in our center from March 2005 to June 2011 were reviewed retrospectively. A single reviewer, following a detailed protocol, analyzed 30 min of each recording to identify the AoV. RESULTS: A total of 619 SBCE procedures were enrolled in the study, including 262 with a PillCam SB1, 148 with a PillCam SB2 and 209 with a MiroCam. AoV was identified in 59 SBCE examinations (9.5%), consisting of 28 with a PillCam SB1 (28/262, 10.7%), 13 with a PillCam SB2 (13/148, 8.8%) and 18 with a MiroCam (18/209, 8.6%) (P = 0.665). The AoV was visualized in 53.2 frames (median 12 frames, range 1-1056 frames); and the detection rate was low regardless of indication, patients' characteristics, SBCE system used or capsule transit parameters. Bile spout was associated with a higher AoV detection (P = 0.003). CONCLUSIONS: The persistently low AoV detection rate using two different SBCE systems underlines the weakness of non-steerable capsule endoscopy. Furthermore, if AoV detection is taken as a surrogate marker of small polyp detection, it becomes obvious both that non-steerable SBCE cannot replace a side-viewing endoscope in the evaluation of periampullary polyps in familial adenomatous polyposis and that it is an infallible method in other small bowel polyposis states.

10 Article QuickView in small-bowel capsule endoscopy is useful in certain clinical settings, but QuickView with Blue Mode is of no additional benefit. 2012

Koulaouzidis, Anastasios / Smirnidis, Alexandros / Douglas, Sarah / Plevris, John N. ·Endoscopy Unit, Centre for Liver & Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK. akoulaouzidis@hotmail.com ·Eur J Gastroenterol Hepatol · Pubmed #22668872.

ABSTRACT: BACKGROUND: Analysis of small-bowel capsule endoscopy (SBCE) is time-consuming. QuickView (QV) has been added to the RAPID software to reduce the reading times. However, its validity is still under intense review. Recently, we have shown that Blue Mode (BM) provides improvements in images for most lesion categories. AIM: To assess the validity of QuickView with white light (QVWL) and QuickView with Blue Mode (QVBM) reading, in a group of patients who underwent SBCE in our centre, by comparing it with the standard video sequence review (used as reference) by experienced SBCE readers. METHODS: This was a retrospective study; all SBCE (August 2008-November 2011), performed with PillCam SB, with complete small-bowel visualization were included. A clinician with previous SBCE experience, unaware of the SBCE reports, reviewed prospectively the video streams on RAPID platform using QVWL and QVBM. All SBCE had been reported previously using the standard mode; these reports were considered as the reference. There were 106 cases of obscure gastrointestinal bleeding (OGIB), 81 cases of known or suspected Crohn's disease (CD) and 10 cases of polyposis syndromes. RESULTS: The mean small-bowel evaluation was 475 (± 270) s and 450 (± 156) s for QVWL and QVBM, respectively. In the OGIB (n=106; 21 overt/85 occult), with QVWL, 54 [P0 (28), P1 (18), P2 (8)] lesions were detected, 63 [P0 (48), P1 (13), P2 (2)] with QVBM, as compared with 98 [P0 (67), P1 (23), P2 (8)] by standard (reference) reporting. For P1+P2 lesions, the sensitivity, specificity, positive predictive value and negative predictive value for QVWL (as compared with reference reporting) were 92.3, 96.3, 96 and 92.8%, respectively. For QVBM, the above values were 91, 96, 96.2 and 90.6%, respectively. Eighty-one (n=81) patients underwent SBCE for small-bowel evaluation on the basis of a clinical history of suspected or known CD. With QVWL, 71 mucosal ulcers were detected, 68 with QVBM, as compared with 155 mucosal ulcers with reference reading. Finally, in the polyposis category with QVWL and QVBM, four polypoid lesions were detected compared with seven with standard (reference) review. CONCLUSION: QV can be used confidently in OGIB in an urgent inpatient setting and in outpatients with occult OGIB or suspected CD. Furthermore, BM does not confer any additional advantage in the QV setting. Standard review settings should be used in all other cases.

11 Article Lewis score correlates more closely with fecal calprotectin than Capsule Endoscopy Crohn's Disease Activity Index. 2012

Koulaouzidis, Anastasios / Douglas, Sarah / Plevris, John N. ·Centre for Liver and Digestive Disorders, Endoscopy Unit, The Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, Scotland, UK. akoulaouzidis@hotmail.com ·Dig Dis Sci · Pubmed #22057284.

ABSTRACT: BACKGROUND: Small-bowel capsule endoscopy (SBCE) is an invaluable imaging method for the small bowel. The Lewis score (LS) and the Capsule Endoscopy Crohn's Disease Activity Index (CECDAI) have been developed to standardize the reporting of small-bowel inflammation. Fecal calprotectin (FC) represents a highly reliable biomarker of intestinal inflammation. AIM: To assess the performance of the two SBCE inflammation scoring systems by correlating them with FC. Furthermore, to define threshold levels for CECDAI. METHODS: Retrospective study; patients who underwent SBCE and had FC measurement shortly before or after SBCE. LS and CECDAI were calculated by a single reviewer and correlated [Spearman's (r ( s ))] with the FC results. Linear regression analysis was used to identify threshold levels for CECDAI. RESULTS: Forty-nine patients; three subgroups A, B and C (based on FC levels <100, 100-200, and ≥200 μg/g, respectively). LS appears to correlate with FC (r ( s ) = 0.448, p = 0.0014), unlike CECDAI, which does not demonstrate significant correlation (r ( s ) = 0.245, p = 0.089). Strongly positive correlation between FC and LS was observed in subgroup A (r ( s ) = 0.68, p = 0.0047), while in subgroups B and C, neither LS nor CECDAI showed correlation with FC. Significant correlation between LS and CECDAI was demonstrated (r ( s ) = 0. 6324, p < 0.0001). Linear regression analysis demonstrates that LS thresholds of 135 and 790 correspond with CECDAI levels of 3.8 and 5.8, respectively. CONCLUSIONS: LS performs better than CECDAI in describing small-bowel inflammation, especially at FC levels of <100 μg/g. Furthermore, CECDAI levels of 3.8 and 5.8 seem to correspond to LS thresholds of 135 and 790, respectively.

12 Article Fecal calprotectin: a selection tool for small bowel capsule endoscopy in suspected IBD with prior negative bi-directional endoscopy. 2011

Koulaouzidis, Anastasios / Douglas, Sarah / Rogers, Marie A / Arnott, Ian D / Plevris, John N. ·Endoscopy Unit, Centre for Liver & Digestive Disorders, The Royal Infirmary of Edinburgh, UK. akoulaouzidis@hotmail.com ·Scand J Gastroenterol · Pubmed #21269246.

ABSTRACT: BACKGROUND AND AIM: Fecal calprotectin (FC) is a non-invasive marker of gastrointestinal inflammation with advocated diagnostic precision in distinguishing inflammatory bowel disease (IBD) from non-IBD diagnoses. FC correlates with abnormalities seen on small bowel barium radiology, but little data exist in relation with small bowel capsule endoscopy (SBCE). To investigate the value of FC as a selection tool for further investigation of the small bowel with SBCE, in a cohort of patients who had negative bi-directional endoscopies, but with continuing clinical suspicion of Crohn's disease (CD). METHODS: We retrospectively correlated the findings of SBCE with FC levels in patients referred with clinical suspicion of CD and negative bi-directional endoscopies. Only patients with FC results prior to the SBCE test were included; in cases of multiple FC determinations, the value closest to the SBCE date was selected. Medications history including usage of aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) was made available for all patients. SBCE findings were analyzed against final diagnosis and FC values. RESULTS: Seventy adult patients were studied (53 females, 17 males). Three cases were excluded, due to capsule retention in the stomach. Median time from FC measurement to SBCE was 62 days. Twenty-three patients had normal FC (≤ 50 μg/g) and in all those the SBCE was normal. Forty-four patients had FC >50 μg/g; in this group, nine patients had FC between 51 and 100 μg/g and all had a normal SBCE. Thirty-five patients had FC levels >100 μg/g; of those, 15 (42.85%) had SBCE findings compatible with CD and mean FC levels 326 μg/g (range 116-1430 μg/g). A definitive clinical diagnosis of CD, based on subsequent follow-up, was made in 10/35 (28.5%) of patients. These 10 patients were within the subgroup of 15 patients with positive SBCE findings and had median FC levels 368 μg/g (range 235-1430 μg/g). CONCLUSIONS: Measurement of FC levels prior to referral for SBCE is a useful tool to select patients with possible small bowel CD. A FC >100 μg/g is good predictor of positive SBCE findings, while FC >200 μg/g was associated with higher SBCE yield (65%) and confirmed CD in 50% of cases. Patients with FC between 50 and 100 μg/g had normal SBCE, despite symptoms suggestive of IBD. In all patients with clinical suspicion of CD and negative bi-directional endoscopies, FC assessment should be carried out prior to their referral for SBCE. Where FC is <100 μg/g (NPV 1.0), SBCE is not indicated.

13 Minor Lubiprostone in small-bowel capsule endoscopy: meta-analyzing the data. 2015

Giannakou, Andry / Dabos, Konstantinos J / Koulaouzidis, Anastasios. ·Faculty of Economics and Management, Open University of Cyprus, Nicosia, Cyprus. · Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, UK. ·Gastrointest Endosc · Pubmed #25805477.

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