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P260 Diagnostic value of capsule endoscopy in small bowel Crohn’s disease following normal radiological imaging

E. Eliadou*, J. Brooks, S. Levison, H. Y. Lee

Central Manchester Foundation Trust, Gastroenterology, Manchester, United Kingdom

Background

Capsule endoscopy (CE) has a superior diagnostic yield compared with small bowel radiology in patients with suspected and established small bowel Crohn’s disease (SB-CD).1 Guidelines recommend CE as the initial diagnostic modality for investigating suspected small bowel CD with normal ileocolonoscopy, but this should be used in the absence of intestinal stenosis.2 We looked at the diagnostic value of CE for non-stricturing SB-CD following normal radiological from our CE database.

Methods

A retrospective review of diagnostic CE database was performed between November 2012 and November 2015. Patients who underwent CE to assess or exclude SB-CD were identified. Presenting symptoms or signs, biochemical abnormalities, and radiological findings were recorded.

Results

In total, 222 CE were performed for suspected CD over 3 years (75 males and 147 females; mean age 44.3 years). Further, 15.7% (35/222) had a definite diagnosis of CD made and 7.6% (17/222) possible CD diagnosed on CE. In addition, 95 patients underwent prior radiological imaging, and of these, 72% (n = 68/95) were normal. CE was detected 13 patients with SB-CD (13/68 = 9%) and 5 patients with possible SB-CD (5/68 = 7.3%) who had normal radiology by MR enterography, CT enterography, and small bowel barium follow-through. Within this group, the most common indications for CE were abdominal pain, nutritional deficiencies, and elevated faecal calprotectin.

Conclusion

CE led to an incremental diagnostic yield of 19% for non-stricturing small bowel CD following normal radiological imaging. The diagnostic yield was greatest in patients with abdominal pain, nutritional deficiencies, and elevated faecal calprotectin

References

[1] Dionisio PM, Gurudu SR, Leighton JA, et al. Capsule endoscopy has a significantly higher diagnostic yield in patients with suspected and established small bowel Crohn’s disease: a meta-analysis. Am J Gastroenterol 2010;105(6):1240–48.

[2] Pennazio M, Spada C, Eliakim R, et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treating small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2015;47:352–86.