P010 - Wireless capsule endoscopy and small intestine contrast ultrasonography (SICUS) in the diagnostic assessment of small bowel in pediatric patients with Crohn's disease

Abstract

Radiological assessment, with either small bowel follow-through (SBFT) or enema is the reference standard in Crohn's disease (CD), for the diagnosis of lesions located in the small bowel (SB) (1) that is not accessible to endoscopy. The radiation exposure limits the use of radiology in the follow-up of CD patients. In adults SICUS, performed after distension of SB lumen with a macrogol solution is comparable to radiological examination in detecting presence, extension and site(s) of SB lesions (2,3). Aim. To evaluate the diagnostic accuracy of SICUS to assess presence, site and extension of SB CD lesions in pediatric patients. Subjects & Methods. Twenty-seven consecutive patients (F 12; age range 11-24 yrs) 21 of whom with the diagnosis of CD (6 previously submitted to surgery) and 6 with the suspect of CD were evaluated after the ingestion of 375 ml of macrogol solution. SICUS findings were compared with those of ileocolonscopy, SBFT, wireless capsule endoscopy (WCE) and surgery. SICUS was performed by a sonologist, unaware of radiological and endoscopic findings. Results. SICUS was well tolerated by all pts. In undiagnosed pts CD was ascertained at SICUS in 5/6 confirmed at endoscopy, at SBFT and/or WCE. In 1 patient with diagnosis of IBS no lesion was found at SICUS, endoscopy and WCE. According to Montreal classification CD patients had 11 B1, 10 B2, and 5 B3 behavior (2 with p); 20 pts with ileocolonic (L3) location, 7 with upper location (L3/L4), 3 with ileo-terminal location (L1), 2 with upper location (L1/L4), 3 with colonic location (L2), 2 with upper location (L2/L4). Terminal/ neoterminal lesions were detected at SICUS in 23 pts, confirmed at endoscopy in 22 and at surgery in 1. Terminal/neoterminal lesions were excluded at SICUS in 1 patient with CD of the colon and in 2 operated pts with no recurrence, confirmed at endoscopy. SICUS detected additional jejunal/proximal ileum lesions in 7 pts confirmed at radiology and/or WCE or surgery. At SICUS the extension of the proximal and distal SB lesions was 20.5±16.8 cm and 17.4±9.5 cm respectively. SICUS detected extra-luminal CD findings in 21/26 pts. Conclusions. These findings indicate that the non invasive procedure SICUS: 1) has a high accuracy for diagnosing Crohn's lesions of the SB, 2) is comparable to endoscopic, radiological examination, in detecting presence and site of SB lesions, and 3) furthermore enables to assess the extension of the SB lesions. These findings support the use of SICUS as a first choice examination in the diagnostic work up and follow up of CD pediatric patients.1. Porto Criteria JPGN 2005. 2. Pallotta et al Lancet 1999. 3. Pallotta IBD 2005