P125 Developments of novel diagnostic findings on capsule endoscopy in the small bowel of patients with Crohn's disease
K. Watanabe*1, A. Noguchi2, T. MIyazaki3, K. Morimoto2, S. Hosomi2, T. Yukawa2, N. Kamata2, H. Yamgami2, S. Nakamura3, T. Arakawa2
1Osaka City General Hospital, Gastroenterology, Osaka, Japan, 2Osaka City University, Gastroenterology, Osaka, Japan, 3Hyogo College of Medicine, Inflammatory Bowel Disease, Nishinomiya, Japan
Definitive diagnosis for Crohn's disease (CD) at an early stage can optimize treatment strategy and can improve prognosis. However, thus far, no specific diagnostic criteria have been established based on the small bowel (SB) findings on capsule endoscopy (CE). In the present study, we aimed to identify and confirm the novel findings using CE in the SB of patients with CD.
We investigated the derivation cohort study and subsequently performed a prospective randomized study. The derivation cohort included 90 cases (cases with established ileitis or ileocolitis CD [n=52], suspected CD [n=8], intestinal Behçet's disease [n=5], and infectious enteritis [n=5], and users of non-steroid anti-inflammatory drug [NSAIDs; n=13] and aspirin [n=7]). Thereafter, we conducted a prospective randomized controlled study to confirm the specific CE findings (UMIN000008199). Three investigators were trained to observe specific findings from among the CE videos; these investigators were then blinded to the clinical backgrounds of patients included in the prospective randomized study, and assessed the CE videos of the patients.
In the derivation cohort, the specific CE findings were determined for 51 CD cases (85.0%). These novel findings included the transition from aphthae to erosion, as well as to small or longitudinal ulcers, as the capsule endoscope progressed towards the distal portion of the SB. These transition of the small bowel lesion (TSL) in patients with CD was observed significantly more frequently in patients with CD than in patients with other diseases (1 of 30 cases, 3.3%: P<0.01). Our prospective randomized controlled study included 20 patients with established ileitis or ileocolitis CD and 20 patients with long-term NSAIDs or aspirin users (11 NSAIDs, 5 aspirin, and 4 both; the control group). All 40 patients were tested for functional patency of the gastrointestinal tract using a patency capsule, of which 14 were confirmed in each group. TSL was accurately diagnosed in 12 of 14 CD patients (85.7%) and was accurately diagnosed in 1 in 14 NSAIDs or aspirin users (7.1%: P=0.02); the difference in the diagnostic accuracy rate was statistically significant. TSL was provided high availability (specificity 85.7%, sensitivity 92.9%, positive predictive value 92.3%, and negative predictive value 86.7%).
TSL is a novel CE finding in SB lesions in CD patients. TSL can be used in the differential diagnosis between CD and other inflammatory bowel diseases in patients with limited distribution of such lesions in the SB during the early stages. Early diagnosis and appropriate optimized treatment may improve prognosis in patients with CD of the SB.