PWE-060 Capsule Endoscopy in The Investigation and Management of Small Bowel Crohn’s Disease

Abstract

Introduction Capsule endoscopy (CE) is increasingly being used to visualise the small intestine in patients with known or suspected Crohn’s disease. The aim of this study was to review the use of CE for this purpose over a two year period in a medium sized DGH following the creation of a new CE service. Methods Electronic records of all patients undergoing CE between 1 st April 2013 and 31 st March 2015 were reviewed. Patients who underwent the procedure to investigate for possible small bowel Crohn’s disease (based on clinical, biochemical and/or endoscopic suspicion) or to assess previously diagnosed Crohn’s disease we identified. Record was also made of contemporaneous faecal calprotectin results and ileal appearances at colonoscopy. Results Twenty-four patients underwent CE to investigate possible small bowel Crohn’s disease. Of these, 11 (46%) had CE findings supportive of Crohn’s disease. 5 of these 11 patients had contemporaneous faecal calprotectin measurement of which 4 (80%) were positive. Eight of these 11 patients had contemporaneous ileal intubation of which 7 (88%) showed evidence of ileitis. Of the 13 patients with normal CE findings, 8 had faecal calprotectin measurement of which only 1 (12%) was positive. Eleven of the 13 patients had contemporaneous ileal intubation of which 4 (36%) showed mild ileitis. Ten patients underwent CE to assess known small bowel Crohn’s disease. CE was normal in 4 cases and showed evidence of active small bowel Crohn’s in 6 cases. Of the 4 patients with normal CE findings, 2 had faecal calprotectin measurement of which both were normal and 3 had ileal intubation which showed no evidence of inflammation in all cases. Of the 6 patients with CE findings suggestive of active small bowel Crohn’s, 5 had faecal calprotectin measurement of which 4 (80%) were normal and all 6 had ileal intubation which showed ileitis in 4 (67%). Conclusion In patients with suspected small bowel Crohn’s disease CE findings supported this diagnosis in nearly half of patients and CE findings correlated well with faecal calprotectin measurement and ileal appearances at colonoscopy. However, in patients undergoing CE to assess known small bowel Crohn’s, CE showed active disease in 57% of patients with normal faecal calprotectin measurement although there was better correlation between CE findings and ileal appearances at colonoscopy. This suggests that CE is an informative test in both the investigation and ongoing management of small bowel Crohn’s disease, and may be a more sensitive test of small bowel Crohn’s disease than faecal calprotectin. Disclosure of Interest None Declared