P272 A pilot study assessing the viability of the Pillcam Colon 2 capsule as a "one-stop" pan-endoscopic test for patients with Crohn's Disease
B. Hall*, G. Holleran, D. McNamara
Adelaide and Meath Hospital, Gastroenterology, Dublin, Ireland
Colon capsule endoscopy (CCE) was developed to provide a noninvasive, painless technique for colonic exploration without sedation and gas insufflation. CCE photographs the small bowel at a similar rate to current small bowel capsules. CCE should be capable of providing images of both small and large bowel in a single minimally invasive investigation. To date, no studies have assessed the potential of CCE to accurately examine both small and large bowel images. This study prospectively assesses whether CCE is a viable method of detecting both small and large bowel Crohn's disease (CD).
Following ethical approval, patients with established CD requiring colonoscopy were recruited. Exclusion criteria included known small bowel stricture and chronic NSAID use. The degree of severity of small bowel disease was graded using the CECDAI score; the degree of severity of large bowel disease was graded using the SES-CD score. CCE and colonoscopy were scheduled within 2 weeks of SBCE. CCE findings were compared with SBCE for small bowel disease and with colonoscopy findings for large bowel disease. Correlations were assessed between variables using Spearman's correlation co-efficient (p value of <0.05 was considered significant).
In total, 10 patients were recruited; median age 31 years (range 19-47), 7 (70%) female, 5 (50%) smokers. All patients had ileo-colonic disease location, 4 (40%) had inflammatory and 6 (60%) had stricturing disease phenotype. In total, 6 (60%) study participants had a previous surgical resection. At SBCE, 2 (20%) participants had a normal small bowel examination (CECDAI = 0), 5 (50%) had mild/moderate disease activity (3.5< CECDAI >5.8) with the remaining 3 (30%) being diagnosed with severe small bowel CD (CECDAI>5.8). In comparison, CCE demonstrated 2 (20%) normal, 6 (60%) mild/moderate with the remaining 2 (20%) severe disease. There was good overall correlation between SBCE and CCE images (R=0.896, p<0.0004). In terms of colonoscopic assessment, 8 (80%) had inactive disease (SES-CD=0-3) with 2 (20%) having mild disease activity (SES-CD=4-10). The majority of participants (9, 90%) were also graded as having inactive disease on CCE with only one participant meeting the criteria for mild disease activity. There appeared to be good overall correlation between the two modalities (R=0.6667, p<0.035).
The future direction of capsule technology is likely to pursue a pan-endosopic approach and this pilot study would suggest that current generation colon capsules have the capability to accurately detect changes consistent with both small and large Crohn's disease.