P123 A single center experience with small bowel capsule endoscopy for patients with established Crohn's Disease: In which patients are lesions found?
N. Viazis*, J. Anastasiou, T. Koukouratos, K. Katopodi, L. Varitimiadis, S. Anastasiadis, P. Karatzas, G. Kechagias, D. Karamanolis
Evangelismos Hospital, Gastroenterology Department, Athens, Greece
The role of small bowel capsule endoscopy in patients with known Crohn's disease has been studied in several trials, which have shown superiority of this test over all other modalities in identifying the severity and extent of the disease. However, it is not clear how often small bowel lesions - apart from the terminal ileum - are found. The aim of our study was to determine frequency and predictors of small bowel involvement in patients with established Crohn's disease.
We reviewed the records of 3740 patients subjected to small bowel capsule endoscopy in our department from March 2003 to March 2014. Among those patients, we identified 641, with known Crohn's disease. All patients had had ileocolonoscopy and upper gastrointestinal endoscopy prior to capsule endoscopy, where biopsies established the diagnosis of Crohn's disease. Patients were then subjected to small bowel capsule endoscopy, if, based on clinical judgment and standard radiographic tests (history of the patient, plain abdominal radiography, computed tomography of the abdomen), there was no evidence of bowel obstruction. Patients in whom suspicion of obstruction could not be excluded were additionally subjected to small bowel follow through, enteroclysis or a patency capsule test prior to capsule endoscopy. Patients in whom small bowel obstruction was seen were not subjected to capsule endoscopy.
Among the 641 patients with established Crohn's disease subjected to capsule endoscopy, small bowel involvement - apart from the terminal ileum - has been identified in 269 (41.96%). According to the statistical analysis predictors of small bowel involvement were age < 40 years old (OR=1.13, 95% CI=1.04-1.23, p=0.041), the presence of upper GI involvement (OR=2.13, CI=1.18-4.77, p=0.010), as well as the presence of lesions in the terminal ileum found at ileocolonoscopy (OR=2.99, 95% CI=1.21-6.14, p=0.012).
Small bowel capsule endoscopy identifies lesions in a substantial number of patients with established Crohn's disease. Younger age and the presence of Crohn's lesions in the terminal ileum and the upper GI tract are predictive of small bowel involvement.