External Validation of the Eliakim Score in Capsule Panendoscopy: An Effective Tool for Diagnosis and Monitoring of Crohn's Disease

Aims Capsule panendoscopy is increasingly used in Crohn's disease (CD), particularly in patients with extensive small bowel and colonic involvement. It offers a non-invasive, one-step evaluation of both segments, making it appealing for disease monitoring and treatment response. However, there is a need for validated scoring systems that objectively assess inflammatory activity in both the small bowel and the colon. The aim of this study was to externally validate the Eliakim Score (Elk-S), developed to assess mucosal inflammation in CD by capsule panendoscopy.

Methods Patients referred for PillCam™ Crohn's examination at our institution were selected, and procedure data were collected retrospectively to calculate the Elk-S [1].

Results A total of 72 patients were included, 62.5% female, with a mean age of 42±15 years. In 52 (72.2%) individuals, the indication for the procedure was suspected CD. Among them, the diagnosis was rejected in 38 cases, while in 14 cases, the diagnosis was established. There was a significant difference in mean Elk-S between the two groups (5.3±1.5 vs. 21.8±5.3, respectively; p<0.001). Capsule panendoscopy was used to evaluate inflammatory activity in 20 (27.8%) patients with CD. Treatment remained unchanged in 10 cases, while therapy was intensified in 10 patients, and there was a significant difference in mean Elk-S between the two groups (2.2±0.5 vs. 17.1±2, respectively; p<0.001). The Elk-S demonstrated an area under the ROC curve of 0.979 for the diagnosis of CD and 0.875 for predicting therapeutic escalation. An Elk-S≥7 had a Sensitivity, Specificity, Negative Predictive Value, and Positive Predictive Value of 100%, 89.5%, 100%, 77.8%, respectively, for the diagnosis of CD. To determine the need for therapeutic intensification in patients with established CD, the same cut-off value showed a Sensitivity, Specificity, Negative Predictive Value, and Positive Predictive Value of 90%, 70%, 87.5%, 75%, respectively.

Conclusions The Elk-S exhibited high accuracy in establishing the diagnosis of CD and was equally useful in predicting the need for therapeutic intensification in cases of established CD. The present study represents the first external validation of the Elk-S, demonstrating its effectiveness for assessing inflammatory activity via capsule panendoscopy of both the small bowel and colon.

Publication History

Article published online:
27 March 2025

• References

• 1 Eliakim R, Yablecovitch D, Lahat A. et al. A novel PillCam Crohn’s capsule score (Eliakim score) for quantification of mucosal inflammation in Crohn’s disease. United Eur Gastroenterol J 2020; 8 (5): 544-551