Abstract

Objective

Monitoring established Crohn’s disease (CD) through a “treat-to-target” strategy aims to reduce and prevent long-term bowel damage and disability. Despite the availability of different monitoring techniques, there is a current lack of integrated evidence to guide optimal monitoring in terms of appropriate tools and timing. Pan-intestinal video capsule endoscopy (PCE) enables non-invasive and direct visualization of the entire intestinal tract with proven safety and efficacy. This study aims to generate insights on the value of PCE for monitoring established CD from the physician’s perspective.

Methods

The Nominal Group Technique (NGT) was used to create discussion around pre-defined research questions aimed at identifying target patient populations for PCE, benefits of PCE in terms of improving disease management, comparative benefits of PCE over standard of care, research priorities to ratify the use of PCE, and hurdles to PCE utilization. A NGT panel was held in Brussels, Belgium in October 2018 with 9 gastroenterology experts. Data were collected from multiple rankings of statements to the research questions and analyzed descriptively.

Results

Consensus indicated that PCE is differentiated from other diagnostic tools, allowing for non-invasive and direct visualization of the luminal intestinal tract in one single procedure. Participants agreed that PCE is beneficial for mapping and grading established CD in all patients, enabling individual and tailored treatment decision-making. Time required to read PCE results was identified as the main utilization hurdle by participants. Well-designed studies are needed to confirm improved outcomes amongst patients with CD managed through a PCE-guided approach.

Conclusions

This study, using the NGT, generated expert opinion on the value of PCE for monitoring established CD in terms of target patient populations and benefits compared to other diagnostic modalities. Participants perceived PCE to facilitate a “treat-to-target” strategy for CD management. Further research is needed to support this value perception.

中文翻译：

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在欧洲使用全肠视频胶囊内窥镜监测确诊的克罗恩病：使用名义小组技术的临床医生会诊

摘要

客观的

通过“靶向治疗”策略监测已确诊的克罗恩病 (CD)，旨在减少和预防长期肠道损伤和残疾。尽管有不同的监测技术，但目前缺乏综合证据来指导在适当的工具和时间方面进行最佳监测。泛肠视频胶囊内窥镜 (PCE) 可实现对整个肠道的非侵入性和直接可视化，并具有经证实的安全性和有效性。本研究旨在从医生的角度深入了解 PCE 在监测已建立的 CD 方面的价值。

方法

名义小组技术 (NGT) 用于围绕预定义的研究问题进行讨论，这些问题旨在确定 PCE 的目标患者人群、PCE 在改善疾病管理方面的益处、PCE 相对于护理标准的比较益处、要批准的研究优先事项PCE 的使用，以及 PCE 使用的障碍。NGT 小组于 2018 年 10 月在比利时布鲁塞尔举行，有 9 位胃肠病学专家参加。从对研究问题的陈述的多个排名中收集数据并进行描述性分析。

结果

共识表明 PCE 与其他诊断工具不同，允许在一个单一的程序中对管腔肠道进行非侵入性和直接可视化。参与者一致认为 PCE 有利于对所有患者的既定 CD 进行映射和分级，从而实现个性化和量身定制的治疗决策。参与者认为阅读 PCE 结果所需的时间是主要的利用障碍。需要精心设计的研究来确认通过 PCE 指导方法管理的 CD 患者的预后改善。

结论

本研究使用 NGT，就 PCE 在监测已建立 CD 的目标患者人群和与其他诊断方式相比的益处方面的价值产生了专家意见。参与者认为 PCE 可以促进 CD 管理的“目标治疗”策略。需要进一步的研究来支持这种价值观。