P145. Small bowel capsule endoscopy for assessing the early postoperative recurrence of Crohn's disease: Correlation with the endoscopic score at 6 and 12 months in a prospective study
G. Condino1, E. Calabrese1, S. Onali1, E. Lolli1, M. Ascolani1, F. Zorzi1, G. Sica2, C. Petruzziello1, F. Pallone1, L. Biancone1, 1Università di Roma Tor Vergata, Medicina dei sistemi, cattedra di Gastroenterologia, Roma, Italy, 2Università di Roma Tor Vergata, Chirurgia, Roma, Italy
The role of Small Bowel Capsule Endoscopy (SBCE) for assessing early Crohn's Disease (CD) recurrence is undefined. In a prospective longitudinal study, we aimed to compare the usefulness of SBCE for assessing the early postoperative recurrence of CD, when using ileocolonoscopy (IC) as gold standard. Whether SBCE visualizes the proximal small bowel (SB) lesions not detected by standard imaging and the interobserver variation was also assessed.
From Feb. 2011-October 2013, all consecutive patients (pts) undergoing ileo-colonic resection for CD were enrolled. Clinical assessment (CDAI) was performed at 3, 6, 12 months (mos). Recurrence was assessed by IC ≤6 mos (T6) and at 12 mos (T12) (Rutgeerts' score: recurrence ≥1). Small Intestine Contrast Ultrasonography (SICUS) was performed at T6 followed, ≤4 wks, by SBCE in pts with no stenosis. CD lesions at SBCE were blindly graded by 2 gastroenterologists (score 0–3, recurrence ≥1; Buchman AJG2004). Statistical analysis: Data expressed as median (range). Student's T test.
Enrolled pts were 26 (17M, age 36, range 19–74). SBCE was not performed in 15 pts, due to impact risk (n = 6), low compliance to perform SBCE (n = 7) or IC (n = 2). At T6, clinical recurrence (CDAI >150) occurred in 1/11 pts performing the 3 procedures and endoscopic recurrence in 9/11 pts (grades: 1:n = 2; 2:n = 4; 3:n = 3). At T6, findings compatible with recurrence were detected by SICUS in 7/11 pts (7TP; 2TN; 2FN) and by SBCE in 10/11 pts (both observers: grade 3:n = 10; grade 0:n = 1; 9TP, 1TN, 1FP; 100% agreement). In 4/11 pts, SBCE showed multiple aphtoid ulcers in the proximal SB not detected by standard imaging. No SBCE retention was observed. At 12mos, 9/11 pts already performed IC, showing recurrence 7/7 pts with evaluable anastomosis (grade 2:n = 5; 3:n = 1; 0:n = 1). When the analysis was restricted to the 7 pts already completing the study, clinical recurrence was observed in 1pt at T6 and in 2pts at T12. The SBCE score at T6 was not correlated with the endoscopic score at T6 (p = 0.19; r = 0.55). Differently, the SBCE score at T6 was significantly correlated with the endoscopic score at T12 (p = 0.004; r = 0.91).
Early after surgery for CD, SBCE may visualize superficial lesions of the proximal SB not detected by standard techniques. The severity of CD lesions assessed by SBCE early after surgery appears significantly correlated with the endoscopic score at 1 year.