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P516 A prospective 24-week mucosal healing and deep-remission assessment of small bowel and colonic Crohn’s disease as detected by colon capsule endoscopy

S. Oliva*1, S. Cohen2, F. Civitelli1, M. Aloi1, F. Viola1, E. Casciani3, F. Maccioni4, C. Hassan5, P. Papoff6, S. Cucchiara1

1Sapienza - University of Rome, Department of Paediatrics, Paediatric Gastroenterology and Liver Unit, Rome, Italy, 2Children’s Centre for Digestive Health Care, Atlanta, United States, 3Sapienza - University of Rome, Department of Emergency Radiology, Rome, Italy, 4Sapienza - University of Rome, Department of Radiological Sciences, Oncology, and Pathology, Rome, Italy, 5Nuovo Regina Margherita Hospital, Gastroenterology Department, Rome, Italy, 6Sapienza - University of Rome, Department of Paediatrics PICU, Rome, Italy

Background

Data on small bowel (SB) mucosal healing (MH) and deep remission (DR) in children with Crohn’s disease (CD) are rare. Colon capsule endoscopy (CCE) has been proved effective as ‘pan-endoscopy’ in paediatric CD. This is the first study to prospectively assess MH and DR on the entire GI tract by performing 2 subsequent CCE over 24 weeks in children with CD in comparison with biomarkers, magnetic resonance enterography (MRE), and SB contrast ultrasonography (SICUS).

Methods

Children with known CD were prospectively recruited and underwent imaging studies followed by CCE, at baseline and after 24 weeks. The Lewis score (LS) and Simple endoscopic score for Crohn’s disease (SES-CD) were calculated for SB and colon, respectively. C-reactive protein (CRP) and faecal calprotectin (FC) were also evaluated for their association with clinical activity, imaging, and CCE findings. Clinical remission was defined as PCDAI<10. SB and colonic MH were defined as LS< 135 and SES-CD ≤ 1, respectively; moderate-to-severe inflammation was defined as LS >790 or SES-CD >7. Biomarker remission (BR) was defined as a combination of clinical remission (PCDAI<10) and normal biomarkers. Deep remission (DR) was defined as a combination of BR and MH. Therapy was calibrated according to CCE results.

Results

In total, 48 patients (pts) were recruited, 22 with clinical and biomarker activity and 26 in remission. At baseline, CCE confirmed significant inflammation (either in SB or colon) in 18 (82%) of 22 pts with clinical and/or biomarker disease activity, and mild lesions and/or normal mucosa in 4 (18%). MRE and SICUS did not demonstrate active disease in 5/18 (23%) with lesions at CCE, but it found nonspecific findings in 2 of 4 with negative CCE. Biomarker levels were elevated with FC in 13 (59%); CRP levels in 10 (45%); and either biomarker in 15 (68%). In the 26 pts with remission, CCE showed SB lesions in 13 (50%) and colonic lesions in 6 (23%). Complete MH and DR were observed in 10 (39%). Imaging studies found lesions in 7 (27%, p < 0.05). At 24-week follow-up, CCE identified DR in 8/20 (36%) of the active group, whereas 12/20 (54%) showed a partial MH. In inactive pts, CCE revealed that 7/10 pts maintained DR. Of 16 pts in remission and with lesions at baseline, CCE showed 9 (56%) achieved DR, and 5 (44%) a partial MH after a change of therapy. MRE and SICUS had a good concordance in evaluating DR (14/17, 82%) in both groups, but did not identify partial MH (only 8/17, 47%, p < 0.05). Use of FC and CRP did not enable accurate evaluation of DR in either group.

Conclusion

This study shows for the first time that CCE is effective for monitoring DR and MH of the entire GI tract and in directing therapy for paediatric patients with CD.