P345 Capsule endoscopy in the diagnostic process of suspected Crohn's Disease
Hennlich, B.(1)*;Madl, C.(2);Pachofszky, T.(2);
(1)Klinik Landstraße, 4. Medizinsche Abteilung für Gastroenterologie und Hepatologie, Vienna, Austria;(2)Klinik Landstraße, 4. Medizinische Abteilung für Gastroenterologie und Hepatologie, Vienna, Austria;
Background
Since more than 20 years, capsule endoscopy (CE) complements endoscopic and radiological examinations, to diagnose diseases of the small bowel (SB), for it allows the direct visualisation of the intestinal mucosa. Although nearly 30% of people suffering from Crohn’s Disease (CD) are affected by an inflammation solely in the SB, this minimally invasive approach is mostly used late in the diagnostic algorithm. Studies concerning indicators of quality of the CE system exist above all for the indication of obscure gastrointestinal bleeding (OGIB), therefore, the aim of this study is to analyse the detection, completion, and complication rate as well as visibility and passage times of the CE in a cohort with suspected CD. Additionally, the different CE models should be compared regarding these parameters and an assessment, which influence the intraobserver-variability exercises on the diagnostic accuracy should be conducted.
Methods
For this purpose, corresponding data out of written CE records from 430 patients in a tertiary hospital in the eastern part of Austria were retrospectively analysed. “Major Lesions” contained aphthoid, ulcerating and stenosing pathologies whereas “Minor Lesions” consisted of mucosal and villous abnormalities. In addition, the diagnose made after a follow-up period of six months was extracted from the individual medical records.
Results
52,8% of the examinations were performed using the CapsoCam system, altogether there was a detection rate of 35,1%, the most frequent detected lesions being aphthoid abnormalities (76,8%). There was a completion rate of 95,4% and an average passage time of 266,94 ± 121,11 minutes. In 1,2% of the cases, a capsule retention occurred with a 1696 times higher chance in the presence of a stenosis. The visibility was rated “good” in 72,6% and the comparison between CapsoCam, PillCam, MiroCam and EndoCapsule showed, that only the completion rate has been associated with the choice of the CE model. After six months, CD has been diagnosed within 26,5% of the patients, resulting in a sensitivity of 70,2%, a specificity of 81,5% and a negative predictive value (NPW) of 84,2%.
Conclusion
Bearing in mind the increasing global incidence of CD and the association between an isolated inflammation in the SB with a poorer prognosis, CE can be highly contributing to an early diagnosis. The method is minimally invasive, patient-friendly, with a low complication rate due to a selective patient evaluation for the indication of suspected CD and the technology is constantly developing. The lack of standardized diagnostic criteria may be an important limitation, especially regarding the diagnostic accuracy, but special endoscopic indices are coming more and more into effect.