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P232 In suspected small bowel Crohn’s disease: Clinical impact of using capsule endoscopy to make decisions

R.A. Gonzalez, E.J. Gómez, L. Pereyra, J.M. Mella, G.N. Panigadi, C. Fischer, M. Roel, D. Cimmino, S. Pedreira, L.A. Boerr

Hospital Alemán, Department of Gastroenterology, Caba, Buenos Aires, Argentina

Background

Capsule endoscopy (CE) can detect small bowel (SB) lesions compatible of Crohn’s disease (CD) in patients with suggestive symptoms but with inconclusive results for the diagnostic workup. However, the clinical impact of CE in helping physicians to make decisions about patients with suspected CD is not currently well established. The aim of the study was to investigate the clinical impact of CE to confirm diagnosis of CD and also to evaluate whether the results of CE modify therapeutic decisions.

Methods

We conducted a single-centre retrospective cohort study. All consecutive adult’s patients submitted to CE for clinical suspected of CD, on period November 2012 to November 2018, were included. Data on demography, previous research, medications for IBD, CE procedures and follow-up were analysed. Multivariate logistic regression analysis was carried out to identify predictors of CD.

Results

A total of 329 CE protocols in adult’s patients were performed over the study period. Ninety were in IBD patients and were included in the analysis 63 CEs submitted for suspected of CD: Clinical suspected CD 54(86%) and colitis unclassified 9 (14%). The mean age was 41 years (range 17–77 years) and 54% were males. The CE reached the caecum in 58 cases (92%) and retention was observed in 5 (8%) with only one patient (1.6%) requiring surgical removal. Overall, 28 of 63 patients (44%) had CE findings consistent with the diagnosis of CD. The lesions identified by CE included ulcers 24 (86%), erythema and villous oedema 17(61%), aphthas and mucosal erosions 5 (18%), stenosis 2 (7%) and were distributed mainly in the distal part of the SB (third tertile) in 23 (82%), but in 14 (50%) cases the proximal SB (first and second tertiles) was also affected. The mean Lewis Score (LS) was 903 (112–4356). Significant inflammatory activity (LS ≥ 135) was detected in 17 (27%) and was moderate or severe (LS > 790) in 7 (11%). CE visualise normal SB mucosa in 34 (54%) of patient’s, which rules out CD. Therapeutic started in 23 (36%) of patients, initiating a new IBD medication in most cases in the 3 months after the CE. On logistic regression analysis, male (p = 0.02) and findings in ileocolonoscopy (p = 0.004) were independents predictors of CD.

Conclusion

In our cohort, CE in suspected CD confirm diagnosis in 44% of cases. Male gender and findings in ileocolonoscopy appear to be independents predictors of CD. CE is a useful tool in suspected CD, since it adds relevant information for diagnosis and had a great impact on therapeutic decisions.