P176. Impact of capsule endoscopy on management of Crohn's disease: A single center experience
F. Dias de Castro1, B. Rosa1, M.J. Moreira1, J. Cotter1
1Alto Ave Hospital Center, Gastroenterology, Guimarães, Portugal
Background: Small bowel capsule endoscopy (SBCE) may be used in the staging of patients with previously diagnosed Crohn's Disease (CD). We aimed to identify the subgroup of patients with CD in which SBCE conducted to restaging and/or modifications in the therapeutic management.
Methods: Retrospective single-center study, including 39 patients with previously diagnosed CD, submitted to SBCE. The variables were duration of the disease, previous therapy for CD and laboratory markers of inflammation and/or severity of CD at the time of SBCE. Primary outcomes were the existence of moderate or severe inflammatory activity on SBCE (Lewis Score, LS ≥790), and treatment modification within six months after SBCE. Statistics were performed with SPSS v.16.0, using Pearson chi-square and Fischer's exact test.
Results: Thirty-nine patients included, 54% female, with mean age 33±14 years. At the time of SBCE, 33% of patients were within the first year after the diagnosis of CD. Serum analysis were: erythrocyte sedimentation rate (ESR) 20.8±16.4 mm/h, C‑reactive protein (CRP) 16.6±26.1 mg/dL, ferritin 92.0±91.7 mg/dL, leucocytes 8171.8±2305.5/µL, platelets 305.769±129.234/µL, hemoglobin 13.3±1.9 g/dL, total protein 7.2±0.7 g/dL, albumin 4.4±0.6 g/dL. Patients had been previously treated with corticosteroids (59%), azathioprine (7.7%) or infliximab (2.6%), and 12.8% had previous surgery related to CD. Six months after SBCE, these figures were significantly higher, 38.5% of patients being treated with azathioprine, 15.4% with biologics, and 7.7% underwent surgery. The presence of anemia was statistically related to higher inflammation at SBCE (LS ≥790). The presence of higher inflammation on SBCE was significantly related to therapeutic adjustments during follow-up (p < 0.05). Additionally, patients with more than one year of evolution of CD, those with high platelet count or low serum protein were also more prone to treatment modifications after SBCE (p < 0.05). Previous therapy with corticosteroids, immunosuppressives, anti‑TNF α or surgery could not predict the need for therapeutic changes after SBCE.
Conclusions: SBCE significantly contributed to modifications in the therapeutic management of CD patients. Treatment was more often adjusted in patients with higher LS on SBCE, corresponding to moderate or severe inflammation. Longer duration of the disease, thrombocytosis and hypoproteinemia were associated to treatment modifications, and could be considered in the selection of CD patients candidates to SBCE.