CE: Capsule Endoscopy in Inflammatory Bowel Disease (IBD) in Children

Sponsor
Children's Mercy Hospital Kansas City (Other)
Overall Status
Completed
CT.gov ID
NCT02182947
Collaborator
Medtronic - MITG (Industry)
45
1
1
76.9
0.6

Study Details

Study Description

Brief Summary

Most of the studies evaluating the roles of MRE and WCE conducted in pediatric patients have been retrospective with the main goal of making a diagnosis in patients with suspected IBD. The current study is the first prospective study in children with known IBD assessing the roles of MRE and WCE in identifying disease exacerbation. This study will help to identify if capsule endoscopy is superior or complementary to MRE in the evaluation of suspected disease exacerbation in IBD patients.

Condition or Disease Intervention/Treatment Phase
  • Device: Capsule endoscopy
N/A

Detailed Description

Proximal small bowel (SB) involvement in CD is associated with a more aggressive disease course and an increased need for surgery.Therefore, accurate determination of SB involvement in pediatric CD is crucial for optimal patient management. Current clinical guidelines include suggested modalities to identify SB involvement and determine management plans. Available options include small bowel series, computed tomography enterography (CTE), small bowel wireless capsule endoscopy (WCE), gadolinium enhanced MRI imaging (GAD MRI), and small bowel contrast enhanced ultrasound (US). The choice of modality is largely determined by available resources, radiation exposure risk, and physician and institutional preferences. MRE and contrast enhanced US are radiation free, while other radiologic modalities entail a risk of radiation exposure. WCE may entail a risk of capsule retention. The risk of capsule retention resulting in obstruction is increased in the context of stricturing or fistulizing disease in CD and has been estimated at 2.6% but may be greatly mitigated by patency capsule screening.

Magnetic resonance enterography (MRE) and small bowel contrast ultrasound (SICUS) have diagnostic effectiveness comparable to other radiological modalities for evaluation of CD patients. However, both studies have their own limitations, MRE is limited by expense, the availability of the requisite equipment and software, variable expertise in interpretation of the findings, and (potentially) the need for sedation in pediatric population. SICUS is similarly affected by being operator dependent with the requisite need of accumulated expertise and heightened need for cooperation during the study that can limit its use in pediatric populations.

Several diagnostic modalities have been evaluated in comparison to WCE in several pediatric and adult IBD studies. The studies conducted in children with IBD were mostly retrospective and aimed at evaluating the role of MRE and WCE for detection of SB disease. They concluded that MRE and WCE were comparable with similar sensitivities. Only three prospective studies (all European) in pediatric IBD have compared WCE and MRE modalities in identifying SB disease involvement. Two were studies in established CD and one in suspected CD and again, they suggested that the tests appear complementary for detection of active CD. The current study is the a another prospective study in children with established IBD in the United States assessing the roles of MRE and WCE in identifying SB disease involvement in IBD. This study provides evidence for capsule endoscopy in the evaluation of established disease exacerbation in patients with IBD in relation to MRE.

Study Design

Study Type:
Interventional
Actual Enrollment :
45 participants
Allocation:
N/A
Intervention Model:
Single Group Assignment
Masking:
None (Open Label)
Primary Purpose:
Diagnostic
Official Title:
Comparison of the Use of Wireless Capsule Endoscopy With Magnetic Resonance Enterography in Children With Inflammatory Bowel Disease
Actual Study Start Date :
Aug 1, 2012
Actual Primary Completion Date :
Dec 30, 2018
Actual Study Completion Date :
Dec 30, 2018

Arms and Interventions

Arm Intervention/Treatment
Experimental: Endoscopy Imaging

Wireless-video capsule endoscopy (WCE) compared to the findings of MRE magnetic resonance enterography in same group of patients.

Device: Capsule endoscopy
Pediatric patients with indeterminate colitis (IC) or Crohn's disease (CD) who are scheduled to undergo routine small bowel screening or surveillance using MRE. Subjects will swallow a patency capsule (PC) to study bowel patency.Those patients, who pass an intact PC, usually within 40 hours, will ingest the wireless capsule endoscopy (WCE). The WCE will be performed within 1 week of completion of MRE.
Other Names:
  • Wireless capsule endoscopy, Pillcam from given imaging
  • Outcome Measures

    Primary Outcome Measures

    1. Diagnostic Yield of Magnetic Resonance Enterography (MRE) [1.5 years]

      The reported positive Magnetic Resonance Enterography (MRE) studies percentage in pediatric patients with known Inflammatory Bowel Disease (IBD) including Crohn's disease (CD) or indeterminate colitis (IC). Diagnostic yield DY of MRE that is the ability of a test to show positive findings to diagnose small bowel Crohns disease based on specified criteria used in the study.The study is positive if it has score of >3 of radiological findings of (SB wall thickness, SB wall enhancement , mucosal and serosal enhancement suggestive of mesenteric fatty infiltration, strictures, comb sign which is increased mesenteric vascularity adjacent to the inflamed bowel loop, reactive mesenteric lymphadenopathy, the presence of fistula, stricture or abscess and the number of SB segments involved).

    2. Diagnostic Yield of Wireless Capsule Endoscopy (WCE) [1.5 years]

      The reported positive Wireless Capsule Endoscopy (WCE) percentage in pediatric patients with known Inflammatory Bowel Disease (IBD) including Crohn's disease (CD) or indeterminate colitis (IC). Diagnostic yield of wireless capsule endoscopy is the ability of this test to detect abnormalities and diagnose positive small bowel crohns disease. The positive (or active) WCE is defined if clear abnormalities of the SB mucosa (ulcerations >3, erosions, polyps, vascular lesions, and bleeding lesions). White lesions within a crater with surrounding erythema were considered ulcers, whereas small superficial white lesions, even with surrounding erythema, were considered erosions.

    Secondary Outcome Measures

    1. Sensitivity of Magnetic Resonance Enterography (MRE) [1.5 years]

      The sensitivity MRE in identifying patients with active vs. inactive CD and IC as defined by the Pediatric Crohn's disease activity index (PCDAI).

    2. Sensitivity of Wireless Capsule Endoscopy (WCE) [1.5 years]

      The sensitivity of WCE in identifying patients with active vs. inactive CD and IC as defined by the Pediatric Crohn's disease activity index (PCDAI)

    3. Specificity of Magnetic Resonance Enterography (MRE) [1.5 years]

      The specificity of MRE in identifying patients with active vs. inactive CD and IC as defined by the Pediatric Crohn's disease activity index PCDAI

    4. Specificity of Wireless Capsule Endoscopy [1.5 years]

      The specificity of WCE in identifying patients with active vs. inactive CD and IC as defined by the Pediatric Crohn's disease activity index PCDAI

    5. Accuracy of Magnetic Resonance Enterography (MRE)Accuracy [1.5 years]

      The accuracy of Magnetic Resonance Enterography (MRE) in pediatric patients with known Inflammatory Bowel Disease (IBD) including Crohn's disease (CD) or indeterminate colitis (IC) in reference to pediatric Crohn's disease activity index PCDAI.

    6. Accuracy of Wireless Capsule Endoscopy (WCE) [1.5 years]

      The accuracy of WCE in pediatric patients with known Inflammatory Bowel Disease (IBD) including Crohn's disease (CD) or indeterminate colitis (IC) in reference to pediatric Crohn's disease activity index PCDAI.

    Eligibility Criteria

    Criteria

    Ages Eligible for Study:
    4 Years to 17 Years
    Sexes Eligible for Study:
    All
    Accepts Healthy Volunteers:
    No
    Inclusion Criteria:
    • Patients aged 4 to 17.99 years at time of investigation

    • IBD/CD and IBD/IC diagnosed based on standard clinical - histologic criteria

    • Patient is scheduled to have MRE as standard of care for evaluation of disease severity/ complication.

    • Signed permission/assent/consent

    Exclusion Criteria:
    • IBD diagnosis not established

    • Recent intestinal tract surgery / resection involving small bowel

    • Use of NSAIDs 4 weeks prior to the Capsule endoscopy study.

    • Patients are on prokinetic medication.

    • Swallowing disorders, esophageal stricture or patients unable to swallow the capsule.

    • Presence of gastrointestinal obstruction or ileus.

    • Patient with implanted electro-medical device or pacemakers.

    Contacts and Locations

    Locations

    Site City State Country Postal Code
    1 Children Mercy Hospital and Clinics Kansas City Kansas United States 66223

    Sponsors and Collaborators

    • Children's Mercy Hospital Kansas City
    • Medtronic - MITG

    Investigators

    • Principal Investigator: Nadia M Hijaz, MD, Children's Mercy

    Study Documents (Full-Text)

    More Information

    Publications

    Responsible Party:
    Nadia Hijaz, MD, Children's Mercy Hospital Kansas City
    ClinicalTrials.gov Identifier:
    NCT02182947
    Other Study ID Numbers:
    • 13080263
    First Posted:
    Jul 8, 2014
    Last Update Posted:
    Mar 11, 2021
    Last Verified:
    Feb 1, 2021
    Individual Participant Data (IPD) Sharing Statement:
    No
    Plan to Share IPD:
    No
    Keywords provided by Nadia Hijaz, MD, Children's Mercy Hospital Kansas City
    Additional relevant MeSH terms:

    Study Results

    Participant Flow

    Recruitment Details
    Pre-assignment Detail
    Arm/Group Title Overall Study
    Arm/Group Description Pediatric patients with indeterminate colitis (IC) or Crohn's disease (CD) who are scheduled to undergo routine small bowel screening or surveillance using Magnetic Resonance Enterography (MRE). Subjects will swallow a patency capsule (PC) to study bowel patency.Those patients, who pass an intact Patency Capsule (PC), usually within 40 hours, will ingest the wireless capsule endoscopy (WCE). The WCE will be performed within 1 week of completion of MRE.Wireless-video capsule endoscopy (WCE) compared to the findings of MRE magnetic resonance enterography in same group of patients.
    Period Title: Overall Study
    STARTED 45
    COMPLETED 27
    NOT COMPLETED 18

    Baseline Characteristics

    Arm/Group Title Overall Study
    Arm/Group Description Pediatric patients with indeterminate colitis (IC) or Crohn's disease (CD) who are scheduled to undergo routine small bowel screening or surveillance using Magnetic Resonance Enterography (MRE). Subjects will swallow a patency capsule (PC) to study bowel patency.Those patients, who pass an intact Patency Capsule (PC), usually within 40 hours, will ingest the wireless capsule endoscopy (WCE). The WCE will be performed within 1 week of completion of MRE.Wireless-video capsule endoscopy (WCE) compared to the findings of MRE magnetic resonance enterography in same group of patients.
    Overall Participants 27
    Age (years) [Mean (Standard Deviation) ]
    Mean (Standard Deviation) [years]
    13.46
    (2.40)
    Sex: Female, Male (Count of Participants)
    Female
    7
    25.9%
    Male
    20
    74.1%
    Race/Ethnicity, Customized (Count of Participants)
    Race Unrecorded
    27
    100%
    Region of Enrollment (Count of Participants)
    United States
    27
    100%
    Body Mass Index BMI percentile of each IBD patients (Percentile) [Mean (Standard Deviation) ]
    Mean (Standard Deviation) [Percentile]
    57
    (32.9)
    Pediatric Crohns Disease Activity Index PCDAI (units on a scale) [Mean (Standard Deviation) ]
    Mean (Standard Deviation) [units on a scale]
    10.2
    (12.5)
    Duration of disease year (years) [Mean (Standard Deviation) ]
    Mean (Standard Deviation) [years]
    1.7
    (2.32)
    Percentage of patients with biologics use with or without immune modulators (Percent of patients) [Number]
    Number [Percent of patients]
    44.4
    Percentage of patients with inflammatory phenotype of IBD (Percent of patients) [Number]
    Number [Percent of patients]
    93
    Percentage of patients with stricturing phenotype of IBD (Percent of patients) [Number]
    Number [Percent of patients]
    7

    Outcome Measures

    1. Primary Outcome
    Title Diagnostic Yield of Magnetic Resonance Enterography (MRE)
    Description The reported positive Magnetic Resonance Enterography (MRE) studies percentage in pediatric patients with known Inflammatory Bowel Disease (IBD) including Crohn's disease (CD) or indeterminate colitis (IC). Diagnostic yield DY of MRE that is the ability of a test to show positive findings to diagnose small bowel Crohns disease based on specified criteria used in the study.The study is positive if it has score of >3 of radiological findings of (SB wall thickness, SB wall enhancement , mucosal and serosal enhancement suggestive of mesenteric fatty infiltration, strictures, comb sign which is increased mesenteric vascularity adjacent to the inflamed bowel loop, reactive mesenteric lymphadenopathy, the presence of fistula, stricture or abscess and the number of SB segments involved).
    Time Frame 1.5 years

    Outcome Measure Data

    Analysis Population Description
    The Diagnostic yield of of MRE were calculated based on how many positive MRE test( with score >3) divided by total number of MRE studies analyzed.
    Arm/Group Title Overall Study
    Arm/Group Description Pediatric patients with indeterminate colitis (IC) or Crohn's disease (CD) who are scheduled to undergo routine small bowel screening or surveillance using Magnetic Resonance Enterography (MRE). Subjects will swallow a patency capsule (PC) to study bowel patency.Those patients, who pass an intact Patency Capsule (PC), usually within 40 hours, will ingest the wireless capsule endoscopy (WCE). The WCE will be performed within 1 week of completion of MRE.Wireless-video capsule endoscopy (WCE) compared to the findings of MRE magnetic resonance enterography in same group of patients.
    Measure Participants 27
    Number [% Percentage of Diagnostic yeild]
    52
    2. Primary Outcome
    Title Diagnostic Yield of Wireless Capsule Endoscopy (WCE)
    Description The reported positive Wireless Capsule Endoscopy (WCE) percentage in pediatric patients with known Inflammatory Bowel Disease (IBD) including Crohn's disease (CD) or indeterminate colitis (IC). Diagnostic yield of wireless capsule endoscopy is the ability of this test to detect abnormalities and diagnose positive small bowel crohns disease. The positive (or active) WCE is defined if clear abnormalities of the SB mucosa (ulcerations >3, erosions, polyps, vascular lesions, and bleeding lesions). White lesions within a crater with surrounding erythema were considered ulcers, whereas small superficial white lesions, even with surrounding erythema, were considered erosions.
    Time Frame 1.5 years

    Outcome Measure Data

    Analysis Population Description
    The diagnostic yield of WCE were calculated based on how many positive SB capsule study detecting SB changes (as defined by positive WCE test) divided by total number of WCE studies analyzed.
    Arm/Group Title Overall Study
    Arm/Group Description Pediatric patients with indeterminate colitis (IC) or Crohn's disease (CD) who are scheduled to undergo routine small bowel screening or surveillance using Magnetic Resonance Enterography (MRE). Subjects will swallow a patency capsule (PC) to study bowel patency.Those patients, who pass an intact Patency Capsule (PC), usually within 40 hours, will ingest the wireless capsule endoscopy (WCE). The WCE will be performed within 1 week of completion of MRE.Wireless-video capsule endoscopy (WCE) compared to the findings of MRE magnetic resonance enterography in same group of patients.
    Measure Participants 27
    Number [% Percentage of Diagnostic yeild]
    37
    3. Secondary Outcome
    Title Sensitivity of Magnetic Resonance Enterography (MRE)
    Description The sensitivity MRE in identifying patients with active vs. inactive CD and IC as defined by the Pediatric Crohn's disease activity index (PCDAI).
    Time Frame 1.5 years

    Outcome Measure Data

    Analysis Population Description
    [Not Specified]
    Arm/Group Title Overall Study
    Arm/Group Description Pediatric patients with indeterminate colitis (IC) or Crohn's disease (CD) who are scheduled to undergo routine small bowel screening or surveillance using Magnetic Resonance Enterography (MRE). Subjects will swallow a patency capsule (PC) to study bowel patency.Those patients, who pass an intact Patency Capsule (PC), usually within 40 hours, will ingest the wireless capsule endoscopy (WCE). The WCE will be performed within 1 week of completion of MRE.Wireless-video capsule endoscopy (WCE) compared to the findings of MRE magnetic resonance enterography in same group of patients.
    Measure Participants 27
    Mean (95% Confidence Interval) [Percent sensitivity]
    100
    4. Secondary Outcome
    Title Sensitivity of Wireless Capsule Endoscopy (WCE)
    Description The sensitivity of WCE in identifying patients with active vs. inactive CD and IC as defined by the Pediatric Crohn's disease activity index (PCDAI)
    Time Frame 1.5 years

    Outcome Measure Data

    Analysis Population Description
    [Not Specified]
    Arm/Group Title Overall Study
    Arm/Group Description Pediatric patients with indeterminate colitis (IC) or Crohn's disease (CD) who are scheduled to undergo routine small bowel screening or surveillance using Magnetic Resonance Enterography (MRE). Subjects will swallow a patency capsule (PC) to study bowel patency.Those patients, who pass an intact Patency Capsule (PC), usually within 40 hours, will ingest the wireless capsule endoscopy (WCE). The WCE will be performed within 1 week of completion of MRE.Wireless-video capsule endoscopy (WCE) compared to the findings of MRE magnetic resonance enterography in same group of patients.
    Measure Participants 27
    Mean (95% Confidence Interval) [Percent sensitivity]
    83.3
    5. Secondary Outcome
    Title Specificity of Magnetic Resonance Enterography (MRE)
    Description The specificity of MRE in identifying patients with active vs. inactive CD and IC as defined by the Pediatric Crohn's disease activity index PCDAI
    Time Frame 1.5 years

    Outcome Measure Data

    Analysis Population Description
    [Not Specified]
    Arm/Group Title Overall Study
    Arm/Group Description Pediatric patients with indeterminate colitis (IC) or Crohn's disease (CD) who are scheduled to undergo routine small bowel screening or surveillance using Magnetic Resonance Enterography (MRE). Subjects will swallow a patency capsule (PC) to study bowel patency.Those patients, who pass an intact Patency Capsule (PC), usually within 40 hours, will ingest the wireless capsule endoscopy (WCE). The WCE will be performed within 1 week of completion of MRE.Wireless-video capsule endoscopy (WCE) compared to the findings of MRE magnetic resonance enterography in same group of patients.
    Measure Participants 27
    Mean (95% Confidence Interval) [Percent specificity]
    57.14
    6. Secondary Outcome
    Title Specificity of Wireless Capsule Endoscopy
    Description The specificity of WCE in identifying patients with active vs. inactive CD and IC as defined by the Pediatric Crohn's disease activity index PCDAI
    Time Frame 1.5 years

    Outcome Measure Data

    Analysis Population Description
    [Not Specified]
    Arm/Group Title Overall Study
    Arm/Group Description Pediatric patients with indeterminate colitis (IC) or Crohn's disease (CD) who are scheduled to undergo routine small bowel screening or surveillance using Magnetic Resonance Enterography (MRE). Subjects will swallow a patency capsule (PC) to study bowel patency.Those patients, who pass an intact Patency Capsule (PC), usually within 40 hours, will ingest the wireless capsule endoscopy (WCE). The WCE will be performed within 1 week of completion of MRE.Wireless-video capsule endoscopy (WCE) compared to the findings of MRE magnetic resonance enterography in same group of patients.
    Measure Participants 27
    Mean (95% Confidence Interval) [Percent specificity]
    83.3
    7. Secondary Outcome
    Title Accuracy of Magnetic Resonance Enterography (MRE)Accuracy
    Description The accuracy of Magnetic Resonance Enterography (MRE) in pediatric patients with known Inflammatory Bowel Disease (IBD) including Crohn's disease (CD) or indeterminate colitis (IC) in reference to pediatric Crohn's disease activity index PCDAI.
    Time Frame 1.5 years

    Outcome Measure Data

    Analysis Population Description
    [Not Specified]
    Arm/Group Title Overall Study
    Arm/Group Description Pediatric patients with indeterminate colitis (IC) or Crohn's disease (CD) who are scheduled to undergo routine small bowel screening or surveillance using Magnetic Resonance Enterography (MRE). Subjects will swallow a patency capsule (PC) to study bowel patency.Those patients, who pass an intact Patency Capsule (PC), usually within 40 hours, will ingest the wireless capsule endoscopy (WCE). The WCE will be performed within 1 week of completion of MRE.Wireless-video capsule endoscopy (WCE) compared to the findings of MRE magnetic resonance enterography in same group of patients.
    Measure Participants 27
    Mean (95% Confidence Interval) [Percent accuracy]
    70
    8. Secondary Outcome
    Title Accuracy of Wireless Capsule Endoscopy (WCE)
    Description The accuracy of WCE in pediatric patients with known Inflammatory Bowel Disease (IBD) including Crohn's disease (CD) or indeterminate colitis (IC) in reference to pediatric Crohn's disease activity index PCDAI.
    Time Frame 1.5 years

    Outcome Measure Data

    Analysis Population Description
    [Not Specified]
    Arm/Group Title Overall Study
    Arm/Group Description Pediatric patients with indeterminate colitis (IC) or Crohn's disease (CD) who are scheduled to undergo routine small bowel screening or surveillance using Magnetic Resonance Enterography (MRE). Subjects will swallow a patency capsule (PC) to study bowel patency.Those patients, who pass an intact Patency Capsule (PC), usually within 40 hours, will ingest the wireless capsule endoscopy (WCE). The WCE will be performed within 1 week of completion of MRE.Wireless-video capsule endoscopy (WCE) compared to the findings of MRE magnetic resonance enterography in same group of patients.
    Measure Participants 27
    Mean (95% Confidence Interval) [Percent accuracy]
    80

    Adverse Events

    Time Frame 1.5 years
    Adverse Event Reporting Description
    Arm/Group Title Overall Study
    Arm/Group Description Pediatric patients with indeterminate colitis (IC) or Crohn's disease (CD) who are scheduled to undergo routine small bowel screening or surveillance using Magnetic Resonance Enterography (MRE).
    All Cause Mortality
    Overall Study
    Affected / at Risk (%) # Events
    Total 0/45 (0%)
    Serious Adverse Events
    Overall Study
    Affected / at Risk (%) # Events
    Total 0/45 (0%)
    Other (Not Including Serious) Adverse Events
    Overall Study
    Affected / at Risk (%) # Events
    Total 0/45 (0%)

    Limitations/Caveats

    Small patient population limits the ability to largely generalize these results.

    More Information

    Certain Agreements

    Principal Investigators are NOT employed by the organization sponsoring the study.

    There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.

    Results Point of Contact

    Name/Title Nadia Hijaz
    Organization Children's Mercy Hospital
    Phone 3139204958
    Email nmhijaz@cmh.edu
    Responsible Party:
    Nadia Hijaz, MD, Children's Mercy Hospital Kansas City
    ClinicalTrials.gov Identifier:
    NCT02182947
    Other Study ID Numbers:
    • 13080263
    First Posted:
    Jul 8, 2014
    Last Update Posted:
    Mar 11, 2021
    Last Verified:
    Feb 1, 2021