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

## TL;DR

This study explores how capsule endoscopy and a blood biomarker can help assess and manage inflammation in children with Crohn’s disease.

## Contribution

The study introduces LRG as a strong predictor of mucosal remission in pediatric Crohn’s disease.

## Key findings

- LS and CECDAI scores showed strong correlation in assessing small bowel inflammation.
- LRG levels below 13.4 µg/mL strongly predicted mucosal remission in pediatric CD patients.

## Abstract

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.