P612 Long-term outcomes of treatment intervention according to the severity of small bowel capsule endoscopy findings in patients with Crohn’s disease: A Japanese single-centre cohort study
M. Nasuno*1, H. Tanaka1, K. Sugiyama1, M. Miyakawa1, S. Motoya1
1Sapporo Kosei General Hospital, IBD Center, Sapporo, Japan
There are few studies about the influence of small bowel capsule endoscopy (SBCE) findings on clinical outcomes in patients with Crohn’s disease (CD). In particular, the influence of the severity of SBCE findings on treatment intervention is unclear. The present study analysed the long-term outcomes of treatment intervention according to the severity of SBCE findings in patients with CD.
We retrospectively collected the data of patients with CD who underwent initial SBCE between January 2015 and December 2017. Patients without lesions in the small intestine and those who received new medications within 3 months after SBCE were excluded from this study. SBCE findings were evaluated using the Lewis score and Capsule Endoscopy Crohn’s disease Activity Index (CECDAI). Treatment intervention was defined as additional treatment involving budesonide, prednisolone (PSL), elemental diet therapy, immunomodulators (IMs), anti-tumour necrosis factor (TNF) agents or intestinal resection. The cumulative rates of treatment intervention following the initial SBCE were estimated using the Kaplan–Meier method. Prognostic factors related to the cumulative rates of treatment intervention were evaluated using the log-rank test. In addition, Lewis and CECDAI scores were categorised into three groups (Lewis score: ≤134, 135–789 and ≥790; CECDAI score: ≤3, 4–9 and ≥10). The cumulative rates of treatment intervention were compared among the three groups of Lewis and CECDAI scores.
The study included 107 patients (median age, 27.1 years; 23 female patients). The median C-reactive protein and albumin levels were 0.09 mg/dl and 4.4 g/dl, respectively. Concomitant treatments with anti-TNF agents, IMs and PSL were administered to 52, 29 and 5 patients, respectively. The median Lewis and CECDAI scores were 230.0 and 6.0, respectively. The 1-, 2- and 3-year cumulative rates of treatment intervention were 12%, 28% and 32%, respectively. In the univariate analysis, median albumin levels ≤4.4 g/dl, Lewis scores ≥230.0 and CECDAI scores ≥6.0 were significantly associated with higher rates of treatment intervention. The 2- and 3-year cumulative rates of treatment intervention according to the Lewis score were as follows: ≤134, 5% and 5%; 135–789, 28% and 31% and ≥790, 44% and 35%, respectively. Similarly, the 2- and 3-year cumulative rates of treatment intervention according to the CECDAI score were as follows: ≤3, 5% and 5%; 4–9, 28% and 29% and ≥10, 58% and 68%, respectively.
This study found that increases in the Lewis and CECDAI scores were associated with increases in the rates of treatment intervention in patients with CD who underwent initial SBCE. The SBCE findings may be able to predict clinical outcomes in patients with CD.