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DOP002 The impact of magnetic resonance enterography and capsule endoscopy on the classification of disease in patients with known Crohn's disease: A PROSPECTIVE ISRAELI IBD RESEARCH NETWORK (IIRN) STUDY

T. Greener1, U. Kopylov*1, D. Yablecovitch1, A. Lahat1, M.M. Amitai2, E. Klang2, S. Neuman1, N. Levhar1, S. Ben-Horin1, R. Eliakim1

1Chaim Sheba Medical Center, Gastroenterology, Tel Hashomer, Israel, 2Chaim Sheba Medical Center, Radiology , Tel Hashomer, Israel

Background

The phenotypic classification of Crohn's disease (CD) (Montreal classification) is important in prediction of the disease course and selection of management strategy. The classification is usually determined at initial diagnosis and is frequently based on ileocolonoscopic and radiologic data. Advanced endoscopic and imaging techniques such as video capsule endoscopy (VCE) and magnetic resonance enterography (MRE) provide additional data regarding the extent of luminal disease and extraintestinal manifestations. Our aim was to prospectively evaluate the impact of MRE and VCE in patients with known small bowel CD (SBCD) on disease classification as compared to the original assessment.

Methods

Seventy six consecutive patients with known SBCD in clinical remission or mild disease (CDAI<220) were prospectively recruited and underwent MRE, and if patency was proven by patency capsule, VCE. Montreal classification was determined upon recruitment and compared to the classification based on the results of the diagnostic evaluation.

Results

Seventy six patients underwent MRE. VCE was performed in 53. Both tests were performed in average of 5.7 years (range 19-0.3) after original diagnosis. VCE and MRE detected new disease location in 56% and 39% of patients, respectively(p=0.27). New proximal disease was detected with VCE and MRE in 50% and 30%, respectively (p=0.13). New colonic disease was identified in 6 cases (8%), 3 cases with each modality. Twenty seven percent of patients originally diagnosed with a benign phenotype (B1) were reclassified as having an advanced phenotype (B2/B3). MRE and VCE reclassified the phenotype in 26% and 10% of cases, respectively (p=0.11). Overall, according to findings of both tests the original Montreal classification was altered in 49\76 patients (64%). Capsule altered classification in 47% mostly by changing the extent of actual disease and MRE changed the classification in 50%, evenly by changing the phenotype and extent.

Conclusion

Video capsule endoscopy and magnetic resonance enterography alter the Montreal classification in a significant percent of Crohn's patients in complete remission. Video capsule endoscopy was significantly more sensitive for detection of proximal small bowel disease. Magnetic resonance enterography was significantly more sensitive in detection of changes in disease phenotype, mostly due to exclusion of patients with severe stricturing disease from performing video capsule endoscopy. The described changes in the disease classification may have an important impact on both clinical management and long-term prognosis in these patients.