P-081 The Use of Serial Wireless Capsule Endoscopy in Treatment Decisions to Improve Outcomes in Small Bowel Crohn’s Disease

Abstract

The role of wireless capsule endoscopy (WCE) in small bowel Crohn’s disease (SBCD) has been studied in many clinical trials and has been shown to be superior to other modalities (eg, barium radiography, colonoscopy with ileoscopy, computed tomography enterography, push enteroscopy) for diagnosing and evaluating non-stricturing SBCD. There has been debate, however, over the utility of SBCE findings for surveillance of mucosal healing and utilizing this data to adjust, individualize, and monitor a variety of treatment plans. Our primary objective was to evaluate whether or not mucosal healing, assessed by WCE, was helpful in decision making to continue or adjust the treatment plan for SBCD patients. We performed a retrospective chart review of patients with confirmed SBCD who had undergone serial WCE between 2001 and 2013. Mucosal healing was determined by a single physician reader and expert in inflammatory bowel disease and, when available, the Lewis Score was utilized to objectively define mucosal healing. Crohn’s Disease Activity Index (CDAI) was also used to determine clinical disease status. Retrospective review revealed whether the findings of a second WCE study resulted in continuation or adjustment of the initial treatment strategy. Twenty-three patients with confirmed SBCD and at least 2 WCE studies were analyzed. Of the 23 patients, 17 exhibited mucosal healing while 6 exhibited non-healing at the time of the second WCE study. Of the 17 cases with mucosal healing, continuing the initial treatment resulted in clinical remission in 15 patients. The remaining 2 patients, despite evidence of mucosal healing, had other complications resulting in the need for treatment changes. Of the 6 patients with evidence of non-healing at the time of the second WCE study, adjusting the treatment strategy by changing to a different drug (n = 3) or different dosage (n = 1) resulted in clinical remission in 4 cases. Two patients with non-healing did not achieve eventual remission, resulting in need for surgery in one, with the other patient entering into a clinical trial. Overall, decision making based on mucosal healing as determined by a second WCE study resulted in eventual remission in 19 out of the 23 patients (83%). Change in treatment based on non-healing as evidenced by WCE findings occurred in 6 out of the 23 patients (26%) and resulting in eventual remission 66% of the time (4 out of 6) while requiring surgery in one patient. This study demonstrates that evidence of mucosal healing based on serial WCE changed the treatment strategy in 26% of patients studied and achieved improved outcomes in 66% of patients requiring treatment change. Larger, prospective trials evaluating the utility of serial WCE for the surveillance and management of SBCE is warranted.