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P123. Accuracy of endoscopic capsule in Crohn's disease diagnosis in an experienced unit

L. Fernández-Salazar, B. Velayos, R. Aller, F. Lozano, L. Del Olmo, A. Macho, L. Ruiz, J. González

Hospital Clínico Universitario, Valladolid, Spain

Introduction: There have been several prospective studies suggesting the utility of endoscopic capsule in the diagnosis of suspected Crohn's disease but in most of them endoscopic capsule findings were not compared with the final diagnosis of the patients.

Aims: To establish the utility and accuracy of endoscopic capsule in Crohn's disease diagnosis in patients with compatible symptoms but without an established diagnosis.

Patients and Methods: From June 2007 to June 2009, 300 capsule procedures were carried out at our hospital to patients from eleven different hospitals in Castilla y León. Capsule readers were experienced having read more than a hundred explorations each. 38 patients were referred for abdominal pain, change of the intestinal habit, weight loss, fever or abnormal radiological exam suggesting bowel disease without an established diagnosis or treatment. PillCam SB capsule (Given Imaging, Yoqneam Israel) was used. Patency capsule was used in 16% of patients. We used no bowel preparation but an overnight fast. Medical data was obtained from capsule application forms and capsule findings were reviewed. 21±6.1 months after the capsula study we asked the physicians by e-mail/ordinary mail or the patients by phone the final diagnosis, any additional diagnostic procedures or the treatment used.

Results: Main age of the 38 patients was 34 years (12–71). 34% were females. 10% had relatives with inflammatory bowel disease. 58% had abdominal pain, 76% changes of intestinal habit, 26% anaemia and 18% elevated RCP. 63% of patients had an upper endoscopy done, 92% a colonoscopy, 47% an ileoscopy. 42% of patients had an ileal biopsy taken. 87% of patients had a barium small bowel follow through examination wich was abnormal in 21% of patients. The capsule did not reach the cecum in 23% patents. Capsule readers considered Crohn's disease as the most probable diagnosis in 37%, as a possible diagnosis in 18% and did not consider it in 45% of patients. Four patients were lost in the follow up. There was one case of intestinal obstruction and surgery due to capsule retention. Crohn's disease diagnosis was confirmed in 44% (15/34 patients) with ileoscopy and biopsy or abdominal TC (4 patients) or response to treatment with mesalamina (5 patients), steroids (3 patients) or azathiorpine (4 patients). Considering patients whose capsule findings suggested Crohn's disease as a probable or possible diagnosis, the sensibility, specifity, positive and negative predictive values of endoscopic capsule in Crohn's disease diagnosis were 80%, 68%, 66% and 81%.

Conclusions: Endoscopic capsule is useful diagnosing Crohn's disease in selected patients. Its most important limitation is the low specificity and positive predictive value which could be improved with more strict criteria. Suspecting Crohn's disease Patency or Agile capsule is recomended.