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P150. Small bowel capsule endoscopy for assessing early postoperative recurrence of Crohn's disease: a prospective longitudinal study

G. Condino1, E. Calabrese1, S. Onali1, E. Lolli1, M. Ascolani1, F. Zorzi1, G. Sica1, C. Petruzziello1, F. Pallone1, L. Biancone1, 1Università Tor Vergata, Roma, Roma, Italy

Background

The role of Small Bowel Capsule Endoscopy (SBCE) for assessing early CD recurrence is undefined. In a prospective longitudinal study, we aimed to compare the usefulness of SBCE for assessing the early postoperative CD recurrence when using ileocolonoscopy (IC) as gold standard. Whether SBCE may visualize upper gastrointestinal (GI) lesions not detected by standard techniques and the interobserver agreement when using SBCE was also investigated.

Methods

From February 2011 to October 2012, all patients (pts) undergoing ileo-colonic resection for CD were enrolled. Clinical assessment (CDAI) was performed at 3, 6, 12 months (mos). IC was performed <6 mo and 12 mo after surgery and recurrence graded (Rutgeerts' score:recurrence ≥1). Small Intestine Contrast Ultrasonography (SICUS) was performed <6 mo after surgery (recurrence: bowel wall thickness >3 mm) followed, within 4wks, by SBCE in pts with no stenosis. Findings compatible with recurrence were graded by 2 independent gastroenterologists (score 0–3: recurrence ≥1;Buchman AJG 2004).

Results

During the study period, 18 pts (12M, median age 47, range 22–65) were enrolled. SBCE was not performed in 9/18 pts, due to strictures (n = 2), low compliance to perform SBCE (n = 3) or IC (n = 2), impact risk (n = 2). Among the 9 pts performing all the 3 procedures early after surgery (≤6 mos), 1 pt showed clinical recurrence (CDAI >150) and 7 pts endoscopic recurrence (grade 1: n = 2; grade 2: n = 2; grade 3: n = 3). Early after surgery, findings compatible with recurrence were detected by SICUS in 6/9 pts (6 true positives [TP], 3 true negatives [TN]) and by SBCE in 8/9 pts (grade 3: n = 8; grade 0: n = 1, according to both observers; 7 TP, 1 TN, 1 false positive [FP]). In 4/9 pts, SBCE showed multiple aphtoid ulcers in the upper GI tract not detected by standard imaging before and after surgery. No SBCE retention and a 100% interobserver agreement was observed. At 12 mo, 7/9 pts already completed the follow up: clinical recurrence was observed in 2 pts with endoscopic recurrence at both <6 mo (grade 1 and 2) and 12 mo (grade 2, both). At 12 mo, 6/9 pts already performed IC, showing recurrence in 3/4 pts with evaluable score (grade 2: n = 3).

Conclusion

Early after surgery for CD, SBCE may be useful for visualizing superficial upper GI lesions not detected by standard techniques. However, the observed development of strictures early after surgery indicates the need of a careful selection of patients, even in the absence of overt symptoms.