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P238. Feasibility of the second-generation colon capsule endoscopy in patients with ulcerative colitis with a reduced preparation regimen

T. Kobayashi1,2,3, N. Hosoe2, K. Matsuoka3, M. Naganuma2, M. Nakano1, Y. Ishibashi3, K. Kimura3, K. Yoneno3, S. Usui3, K. Kashiwagi2, T. Hisamatsu3, N. Inoue2, H. Serizawa1, N. Watanabe1, T. Kanai3, H. Imaeda4, T. Hibi3, H. Ogata2, 1Kitasato University Kitasato Institute Hospital, Inflammatory Bowel Disease Center, Tokyo, Japan, 2Keio University, Center for Diagnostic and Therapeutic Endoscopy, Tokyo, Japan, 3Keio University, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokyo, Japan, 4Department of General Internal Medicine, Saitama Medical University, Saitama, Japan

Background

Patients with ulcerative colitis (UC) may need frequent colonoscopy for monitoring disease activity, as endoscopic mucosal healing is emerging as a critical parameter to optimize the management strategy. Therefore, increasing the patient's tolerability for colon endoscopy is crucial in the management of UC. Second-generation colon capsule endoscopy (CCE-2) serves as a noninvasive diagnostic tool in screening colorectal neoplasms with improved endoscopic images. However, unlike conventional colonoscopy, incapability of aspirating the luminal content by the device requires larger colonic preparation volume, as much as 5 to 6 L of polyethylene glycol (PEG). In this study we hypothesized that 1) CCE-2 is a feasible method to visualize the mucosal inflammation in UC, and 2) a smaller volume of bowel preparation may be sufficient for the purpose of evaluating disease activity in UC patients.

Methods

Study 1: Twenty-nine patients with UC ingested CCE-2 followed by the single dose of 2L PEG in combination with prokinetics (mosapride citrate and metoclopramide). Findings were recorded for 8 hours and conventional colonoscopy was subsequently performed on the same day. Completion rate was calculated based on the excretion of capsule in 8 hours, and the bowel cleanliness was scored in a 4-point grading scale (poor, fair, good, and excellent) for 5 sections of colon (cecum, ascending, transverse, proximal left-side, and distal left-side). Matts' endoscopic grades were determined and compared by both CCE-2 and conventional colonoscopy for each section. Four endoscopists blinded for the conventional colonoscopic findings scored bowel cleanliness and disease severity. Study 2: Preparation protocol was further modified in 20 patients with split-dose of bowel preparation. Briefly, CCE-2 was ingested 2 hours after 700 ml of PEG, followed by the booster dose of 900–1500 ml isotonic magnesium citrate solution.

Results

Study 1: Completion rate was 69.0% (20/29). Matts' endoscopic grades showed a strong correlation between CCE and conventional colonoscopy in all sections (overall average ρ = 0.797, Spearman's rank correlation coefficient test) despite bowel cleanliness seeming insufficient (good or excellent <50%). Study 2: Completion rate was improved up to 85.0% (17/20) with comparable quality of images to Study 1.

Conclusion

CCE-2 is a well-tolerated and feasible tool for evaluating disease activity in UC. Endoscopic severity score obtained by CCE-2 was comparable with conventional colonoscopy.