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P142 Quantification of inflammation in small bowel Crohn's disease (SBCD) patients by videocapsule endoscopy (VCE) and magnetic resonance enterography (MRE)

U. Kopylov*1, E. Klang2, S. Ben-Horin3, D. Yablecovitch3, A. Lahat3, S. Neuman3, N. Rozendorn2, N. Levhar3, M.M. Amitai2, R. Eliakim3

1Sheba Medical Center, Gastroenterology, Tel Hashomer, Israel, 2Sheba Medical Center, Department of Diagnostic Imaging, Tel Hashomer, Israel, 3Chaim Sheba Medical Center, Gastroenterology, Ramat Gan, Israel

Background

Video capsule endoscopy (VCE) and MRE are the prime modalities for the evaluation of SBCD.. Mucosal inflammation on VCE can be quantified using the Lewis score (LS)or the Capsule Endoscopy Crohn's Disease Activity Index (CECDAI), incorporating mucosal edema, ulceration and strictures. Magnetic Resonance Index of Activity (MaRIA) is a novel MRE-based score that incorporates wall thickness, relative contrast enhancement, mucosal ***edema and ulceration in the distal SB and colon The aim of this study was to compare the quantification of distal SB inflammation using VCE and MRE-based diagnostic indices.

Methods

Patients with known SBCD in steroid free clinical remission or with mild symptoms (CDAI<220) for at least 3 months were prospectively recruited and underwent MRE, followed by Agile patency capsule. If patency was proven, VCE was performed. LS, CECDAI and MaRIA scorewere calculated for the distal SB. C-reactive protein (CRP) and fecal calprotectin (FC) levelswere obtained and evaluated for their association with the clinical scores

Results

Fifty patients underwent both VCE and MRE. Active disease was demonstrated in the distal SB in62% of the patients by VCE and 72% by MRE (p=0.4). There was a strong correlation between MaRIA score and both VCE indices (LS-r=0.53, p=0.001; CECDAI- r=0.49, p=0.001), as well as between the CECDAI and LS (r=0.677, p=0.001). LS associated with mucosal healing (<135) correlated with a mean MaRIA score of 13.3 and a mean CECDAI of 4.9 by linear regression. CRP had moderate correlation with MaRIA (r=0.38, p=0.01) but not with VCE scores (LS- r=0.1 p=0.5 CECDAI-r=0.24, p=0.1). FC was significantly correlated with all scores, however the association was somewhat stronger for the VCE scores (MaRIA- r=0.44 p=0.02; LS - r=0.54 p=0.001; CECDAI- r=0.49, p=0.001).

Conclusion

Significant correlation between the quantitative MRE and CE-based indices of inflammation in the distal SB was observed. A significant correlation was also demonstrated between LS and CECDAI. FC levels better correlated with VCE then with MRE score, while CRP had a good correlation with the MaRIA score only. The utility of these indices for prediction of future clinical relapse will be prospectively evaluated in future studies.

UK and EK equally contributed to the study

RE and MM equally contributed to the study