P105 A single center experience with small bowel capsule endoscopy for patients with established Crohn's disease: When is it safe?

Abstract

Background: The role of small bowel capsule endoscopy in patients with known Crohn’s disease has been studied in several trials, which have shown superiority of this test over all other modalities in identifying the severity and extent of the disease. However, fear exists as regards the possibility of capsule retention, which has been reported to occur in 0 13% of patients subjected to the test. The aim of our study was to determine the risk of small bowel capsule retention in patients with known Crohn’s disease, in a large, single-center, referral hospital for inflammatory bowel disease. Methods: We reviewed the records of 2300 patients subjected to small bowel capsule endoscopy in our department from March 2003 to March 2011. Among those patients, we identified 301, with known Crohn’s disease. All patients had had ileocolonoscopy prior to capsule endoscopy, where biopsies established the diagnosis of Crohn’s disease. Patients were then subjected to small bowel capsule endoscopy, if, based on clinical judgment and standard radiographic tests (history of the patient, plain abdominal radiography, computed tomography of the abdomen), there was no evidence of bowel obstruction. Patients in whom suspicion of obstruction could not be excluded were additionally subjected to small bowel follow through, enteroclysis or a patency capsule test prior to capsule endoscopy. Patients in whom small bowel obstruction was seen were not subjected to capsule endoscopy. Results: Among the 301 patients with established Crohn’s disease subjected to capsule endoscopy, small bowel involvement has been identified in 196 (65.1%). Capsule retention occurred in 5 patients (1.66%). In 3 of them capsule was finally excreted, after corticosteroid therapy, while the remaining 2 patients had to be operated. Conclusions: Small bowel capsule endoscopy in patients with established Crohn’s disease is safe, since, in the majority of cases, clinical and/or radiographic data can be used to identify those with a suspicion of stricturing disease, who have to be excluded from the test. In the remaining cases the percentage of capsule retention is small and in most instances can be managed conservatively.