P290 Determination of small-bowel patency in Crohn’s disease - a prospective study

Abstract

Patency capsule (PC) is usually performed to establish small-bowel patency, previously to capsule endoscopy (CE), in patients with an increased risk of CE retention. Notably, the reported patency capsule retention rate is significantly higher than the expected for Crohn’s disease (CD). Our aims were to assess small-bowel patency in CD patients, to determine the precise location of the retained PC, as well as to evaluate predictive factors for PC retention. Prospective single-centre study including CD patients with indication for small-bowel CE, between December 2015 and February 2017. PillCam® patency capsule was performed in all patients to access small-bowel patency; PC was ingested, after a 12-h fasting period, without previous bowel preparation. In all patients with a positive radiofrequency identification tag (RFIT) scanner identification of the PC, at 30 h after ingestion, an abdominal-CT was performed in order to determine its precise location. Fifty-four patients were included. 65% of patients were female and the mean age was 40.5 ± 11.1 years. Twelve (22%) patients had a known or suspected small-bowel stenosis detected by previous ileocolonoscopy or abdominal imaging. Twelve (22%) patients had a history of abdominal surgery (intestinal resection: n = 7). The PC retention rate at 30 h was 20% (11 patients). These patients were then submitted to abdominal-CT, which revealed a small-bowel retention only in 5 (9%) cases. Higher CRP levels, penetrating disease and a history of abdominal surgery were associated with increased risk of PC retention (p = 0.007, p = 0.011 and p = 0.033, respectively). On multivariate analysis, there was an independent association between small-bowel patency capsule retention and CRP levels >5mg/dL (OR = 15.5; p = 0.03). The PC small-bowel retention rate in CD was 9%, and even higher in patients with increased CRP levels. Our results show that, with this sequential CT protocol, the false positive cases of RFIT scanner or plain abdominal X-ray may be avoided. This may contribute to a more effective application of CE without the risk of small-bowel retention.