Utility of Small Bowel Capsule Endoscopy and Leucine-Rich Alpha-2-Glycoprotein in Pediatric Crohn’s Disease Management

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Introduction Mucosal remission is a key treatment goal for Crohn's disease (CD). Small-bowel capsule endoscopy (SBCE) is a minimally invasive modality for evaluating small-bowel mucosa; however, standardized criteria for mucosal remission have not yet been established. This study aimed to investigate the correlation and comparative sensitivity of the Lewis score (LS) and Capsule Endoscopy Crohn's Disease Activity Index (CECDAI) in assessing small-bowel inflammation in pediatric Crohn's disease (CD) and to evaluate biomarkers as predictors of small bowel mucosal remission. Methods This cohort study included pediatric patients with CD at a single center in Japan. Demographics, clinical symptoms, serum C-reactive protein (CRP) levels, erythrocyte sedimentation rate (ESR), and leucine-rich alpha-2 glycoprotein (LRG) levels were evaluated. SBCE findings were scored using LS and CECDAI. Results Among 26 patients, 54 SBCEs were performed, as some patients underwent multiple examinations. Median LS and CECDAI scores were 403 and 12, respectively. LS and CECDAI showed positive correlation (ρ = 0.82, p < 0.001). LS values of 135 and 790 corresponded to CECDAI of 7.1 and 16.5, respectively. Among 32 clinical remission cases, 24 had LS ≥ 135, while 17 had CECDAI ≥ 7.1. CRP, ESR and LRG correlated with SBCE findings, with LRG showing the strongest association (ρ = 0.74, p = 0.01). LRG < 13.4 µg/mL predicted small bowel mucosal remission. Conclusions LS and CECDAI showed a strong correlation, supporting their utility in evaluating small bowel inflammation in pediatric Crohn's disease. LS may have a tendency to detect milder or subclinical inflammatory changes, although the magnitude of this difference should be interpreted cautiously. In addition, LRG < 13.4 µg/mL strongly predicted mucosal remission, and these findings, though limited by sample size, suggest that LRG combined with clinical indices could serve as a noninvasive adjunct for timing SBCE.

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