P207 It’s time to include capsule endoscopy to assess mucosal activity as part of the ‘treat-to-target’ strategy in Crohn’s disease: a real-life experience from a reference center in Argentina

Abstract

Abstract Background The evaluation of the small bowel (SB) in known Crohn’s disease (kCD) has a significant impact on prognosis with potential therapeutic implications. The treat-to-target strategy is widely accepted, emphasizing that endoscopic healing is associated with improved long-term outcomes. Although capsule endoscopy (CE) shows promise in monitoring the small bowel in kCD, there is limited evidence supporting routine use. The aim of this study was to investigate clinical utility of CE to assess activity and extension of kCD and to evaluate whether the results of CE modify the therapeutic decisions. Methods We conducted a single center retrospective cohort study. Adult patients submitted to CE for kCD from Nov-2012 to Nov-2023 were included. Data on demography, previous research, medications for IBD and follow-up were analyzed. Univariate analysis was carried out to identify CE features associated with changes in therapeutic management. A p value <0.05 was considered statistically significant. Results A total of 572 CE protocols were performed, of which 76 were in kCD adult patients. The mean age was 36 years (range 16–76), 59% were males and median disease duration was 5.4 years. The CE reached the cecum in 97% and retention was observed in only two patients (2.6%) without necessity of surgical removal. Thirty two of 76 CE protocols (42%) had findings consistent with mucosal activity of CD. The lesions identified by CE included ulcers 30 (39%), erythema and villous edema 21 (28%), stenosis 2 (3%) and were distributed mainly in the distal part of the SB (3rd tertile) in 27 (35%), but in 15 (20%) the proximal SB (1st and 2nd tertile) was also affected. The mean Lewis Score (LS) was 576 (135-5392). Normal or clinically insignificant inflammatory changes (LS <135) ruled out SB mucosal activity in 44 (58%) patients. The results of the CE modified therapeutic decisions in 29 (38%) patients as follows: 17 were started new biological therapy and 7 were optimized. CEs consistent with mucosal inflammatory activity (LS ≥135) were more frequently associated with changes in therapeutic management (OR: 11, 95% CI 4-35, p: 0.04). When both magnetic resonance enterography (MRE) and CE were utilized to assess SB mucosal activity, diagnostic yields of MRE and CE were 45% and 42% respectively. But of the 8 patients with proximal SB affected in CE, only 1 showed inflammatory activity in the MRE. Conclusion In our cohort, CE in patients with kCD added valuable clinical information and had a great impact on therapeutic decisions. These results suggest that CE could be incorporated into the treat-to-target strategy for patients with CD. However, randomized controlled trials are required to confirm this recommendation.