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DOP032. Clinical impact and safety of capsule endoscopy in patients with established Crohn's disease - a multicenter cross-sectional study

U. Kopylov1, A. Nemeth2, A. Koulaouzidis3, R. Makins4, W. Afif5, G. Wild1, A. Bitton1, G.W. Johansson6, T. Bessissow1, E. Toth6, E.G. Seidman1, 1McGill University Health Center, Gastroenterology, Montreal, Canada, 2Skåne University Hospital, Lund University, Department of Gastroenterology, Malmo, Sweden, 3Royal Infirmary of Edinburgh, Endoscopy Unit, Centre for Liver and Digestive Disorders, Edinburgh, United Kingdom, 4Gloucestershire Hospitals NHS Foundation Trust, Gastroenterology, London, United Kingdom, 5McGill University, Division of Gastroenterology, Montreal Quebec, Canada, 6University Hospital Skane, Gastroenterology-Hepatology Division, Malmö, Sweden

Background

Videocapsule endoscopy (VCE) enables noninvasive visualization of the entire small bowel (SB) mucosa. Multiple studies have established the exceptional accuracy of VCE for the diagnosis of small bowel Crohn's disease (CD). VCE is also useful in patients with an established diagnosis of CD. However little data is available on the therapeutic impact of VCE findings in patients with established CD.

Aims: To examine the impact and safety of VCE on the management of patients with established CD.

Methods

Retrospective multicenter cross-sectional study. The study cohort included consecutive patients with established CD who underwent VCE in 4 academic referral centers (1 Canada, 1 Sweden, 2 UK) from November 2008 to October 2013. Patients were excluded if VCE was performed as a part of the initial diagnosis of CD. The presence of small bowel mucosal inflammation on VCE was quantified using the Lewis score (LS). Normal VCE was defined as LS < 135, mild to moderate inflammation as 135 < LS < 790, and moderate to severe as LS > 790. Fecal calprotectin (FCP) was determined either by ELISA (positive >200 µg/g) or a rapid semi-quantitative test (positive >100 µg/g).

Results

The characteristics of the 133 patients included in the study included: mean age 31 (14–70) years, mean age at onset - 23 (7–68) years, male 39.5%; disease location: ileal 41.3%, ileocolonic 34.2%, colonic 25.5%. VCE was normal in 28%, mild to moderate in 43.2%, and moderate to severe inflammation in 28.8% of the patients, with mean LS of 1194±1573.

Management was changed as a result of VCE findings in 49.9% of the patients (including initiation or intensification of an immunomodulator/biologic, initiation of a corticosteroid, referral to surgery). CRP was elevated in 42.1%, and FCP in 63% of the available patients. Elevated FCP had a sensitivity of 69%, specificity of 40%, positive predictive value (PPV) of 48.9%, negative predictive value (NPV) of 61.5% for LS above 790, while elevated CRP had a sensitivity of 60.4%, specificity of 68%, PPV of 61.9 and NPV of 66.7% for LS above 790. If VCE was limited to patients with positive inflammatory markers only, significant SB inflammation would have been missed in 33–38% of the patients.

Symptomatic capsule retention occurred transiently in 1 patient (0.7%), with spontaneous resolution.

Conclusion

VCE findings had a significant impact on the management of patients with established Crohn's disease. VCE should not be limited to patients with positive inflammatory markers as their predictive value for significant SB inflammation is moderate at best. Capsule retention was very rare and did not require invasive intervention.