P204. Small bowel capsule endoscopy in Crohn's disease: Detection of upper gastrointestinal lesions, impact rate, gastric and small bowel transit times in a tertiary referral center
G. Condino1, S. Onali1, C. Petruzziello2, E. Lolli1, F. Zorzi1, E. Calabrese3, M. Ascolani1, F. Pallone4, L. Biancone1
1Tor Vergata University, Rome, Italy; 2Tor Vergata University, Gastroenterology, Rome, Italy; 3Tor Vergata University, Cattedra di Gastroenterologia, Dipartimento Di Medicina Interna, Rome, Italy; 4Tor Vergata University, Dip di Medicina Interna, Rome, Italy
Background: Small bowel capsule endoscopy (SBCE) may visualize small bowel lesions not detected by conventional techniques. The role of SBCE in Crohn's Disease (CD) is under investigation. We aimed to evaluate, in a retrospective cohort study, the usefulness of SBCE for assessing the extent of the lesions in small bowel CD. The rate of SBCE impact and interindividual variations in terms of gastric and small bowel transit times were also assessed.
Methods: All SBCE performed from June 2004 to Sept. 2010 in patients (pts) with small bowel CD referring at our tertiary IBD center were reviewed. Inclusion criteria: (1) Small bowel CD assessed by conventional techniques; (2) Detailed clinical history; (3) No stenosis/obstructions; (4) Small bowelCD assessed by entero-CT/-MRI, small intestinal contrast ultrasonography, barium follow through and/or ileocolonoscopy (IC) within 6mths from SBCE; (5) SBCE images reviewed by one single gastroenterologist. SBCE performed using the Given Pillcam SB (Given, Israel) after 2L PEG. Findings considered: (a) CD extent before vs after SBCE; (b) upper GI lesions (i.e. above the distal ileum proximal to the valve or to the anastomosis); (c) SBCE transit times; (d) impact rate.
Results: A total of 40 CD pts (20M, median age 34 yrs, range 1870) fulfilled the inclusion criteria. Previous ileo-colonic resection was shown by 29/40 (72.5%) pts (median interval 10mths, range 3300). CD localization involved the ileum in 37/40 (92%) CD (recurrence in 26/37) and also the upper GI in 4/37 (10%), while 3 pts showed no recurrence. SBCE showed marked interindividual variations in terms of gastric (median 29min, range 3360) and small bowel transit times (valve: median 350min, range 240433 or anastomosis in resected CD: median 231 min, range 61466). SBCE did not visualize the entire small bowel in 9/40 (22.5%) pts (5/11 CD not resected, 4/29 resected pts). Upper GI lesions were detected by SBCE in 23/40 (57.5%) pts, known before SBCE in only 4/40 (10%) pts. In one pt, SBCE visualized an ulcerated jejunal stenosis requiring surgery not detected by SBFT and IC. In 1/40 (2.5%) pts, SBCE impact requiring surgery within a cul de sac of an ileo-ileal anastomosis was observed.
Conclusions: Upper GI lesions may be detected by SBCE in a high proportion of CD pts, although their clinical relevance needs to be determined. Before SBCE, CD pts need a careful selection due to possible incomplete small bowel visualization and to the impact risk occurring also in the absence of stenosis.