P278 Pan-enteric capsule to assess treatment effects of vedolizumab in IBD patients: A 1 year proof of concept study
Thakor, A.(1);Johnson, M.(2);Wye, J.(2);
(1)The Luton and Dunstable University Hospital, Gastroenterology Department, Luton, United Kingdom;(2)The Luton & Dunstable University Hospital, Gastroenterology Department, Luton, United Kingdom; Matt W. Johnson Luke B Johnson John Wye
Pan-enteric capsule (PEC) endoscopy may be an acceptable alternative to more invasive endoscopy in the assessment of patients with IBD. These patients require endoscopic assessment of disease extent and severity to guide both initiation and continuation of biological therapy. There are many potential benefits including: increased patient comfort, lower complication risk, no sedation related risks and greater convenience for the patient.
Vedolizumab is an effective biological agent for both UC and Crohn’s disease. Previous studies largely concentrated their endoscopic analysis on improvements seen within the colonic mucosa. However, less is known about the effects of Vedolizumab on the small bowel Crohn’s disease.
Using a pan-enteric capsule (PillCam Crohn’s Capsule, Medtronic, USA), we evaluated the symptomatic, clinical and endoscopic improvements seen in a group of IBD patients over a 1 year treatment course of Vedolizumab. We also assessed any patient preference for PEC as opposed to colonoscopy.
A group of 10 patients starting Vedolizumab were evaluated at 0, 6 and 12 months via PEC, rather than colonoscopy +/- small bowel capsule/MRI. Biochemical and clinical evaluation used ESR, Calprotectin and symptomatic scores (HBI or mUCDAI). The extent and severity of the underlying Crohn's disease was assessed using the Eliakim score, which has shown strong inter-reader reliability and moderate-to-strong correlation with the Lewis score. Questionnaires were completed post procedure to determine patient acceptability.
We found the average ESR reduced from 30 (range 7-81) to 12.1 (2-31) after 1 year of Vedolizumab. Likewise, the average faecal calprotectin dropped from 1263.6 (189->1800) to 440.1 (30-1460). The modified UCDI score and modified HBI reduced from 5 to 0, and 7.5 to 3.5, respectively. The average small bowel PillCam Crohn’s Capsule Score reduced from 5 to 2.8, whilst the Eliakim Score dropped from 13.6 (6-30) to 5.2 (0-22).
The comfort score for PEC was on average 9.5/10, with all 10 patients reporting a preference to continue with PEC evaluation in the future.
PEC provides an excellent evaluation of the pan-intestinal extent and severity of IBD, and the effects of a treatment regime. We feel PEC should be considered as a 1st line assessment tool when evaluating the effectiveness of biological therapy in IBD patients, especially those with small bowel Crohn’s disease. Whilst Vedolizumab has already been shown to be beneficial in the treatment of colonic inflammation, this proof of concept study also demonstrated its beneficial effect in reducing inflammation across all 3 segments of the small bowel in those with Crohn's disease.