Sa1634 Wireless Capsule Endoscopy Improves Outcomes in Nonstricturing Crohn's Disease: an Evaluation of Pre- and Post-Treatment Capsule Endoscopy (CE)

Abstract

Wireless Capsule Endoscopy Improves Outcomes in Nonstricturing Crohn’s Disease: an Evaluation of Preand PostTreatment Capsule Endoscopy (CE) Neel K. Mann*, Simon K. Lo Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA Background: Capsule endoscopy has been demonstrated to be superior to standard endoscopic and radiographic modalities in diagnosing small bowel Crohn’s disease (CD). Yet its use for assessment of and tracking treatment response has not been fully established. Aim: To assess small bowel mucosal healing based on the Capsule Endoscopy Crohn’s Disease Activity Index (CECDAI). Dig Dis Sci(2008)53:1933-137. Methods: Retrospective review of capsule endoscopy (CE) in patients with suspected and known small bowel nonstricturing Crohn’s disease (CD). CEs were read by two high experienced CE readers ( 1000) who were not the managing IBD physicians. Results: 2190 capsule endoscopies were performed between Oct 2001-Oct 2012. 158 subjects underwent 2 capsule endoscopies during that time interval. Of those 158 subjects, 28 had known or suspected CD for a total of 65 CE. 17/28 (60.7%) were female with an average age 32 years (range 8-70). The cecum was reached in 48/65 (73.8%) of CE examinations and there were no capsule retentions. Indications for each CE included abdominal pain (46.1%), diarrhea (24.6%), anemia (10.8%), gastrointestinal bleed (4.6%), weight loss (3.1%), growth failure (13.8%), extent of CD ( 26.2%), pouchitis (1.5%), extraintestinal manifestations of CD (1.5%).The average time interval between preand post-treatment CE was 27 months (range:1-81 months). 57/65 (87.7%) were 8-hr CE vs 12-hr CE 8/86 (12.3%). Of the 28 subjects, 17 had known CD at the time of the pre-CE; 7 had suspected CD; 3 had IBD-U (10.7%); and 1 had UC. 7/11 (63.6%) with suspected CD or IBD-U/UC were re-classified as CD and treated as such after pre-CE. CE results prompted escalation of therapy or switching of biologic agents in 15/28 (53.6%). Post-CE CECDAI showed statistically significant (p .025, Fisher’s paired t test) improvement in mucosal healing in 11/15 (73%). CRP data was available in 18 patients within 3 months of preand post-treatment CE. The mean pre-CE CRP was 0.66 mg/dl and post-CE was 0.43 mg/dl but the difference was not statistically significant (p 0.2063 per paired t test). Conclusions: Capsule endoscopy was able to re-classify disease phenotype in 60% of those patients with suspected Crohn’s disease or IBD-U, thereby potentially changing the management outcome of these patients. More importantly, CE demonstrated mucosal healing in 70% of patients after escalation of therapy in patients with nonstricturing phenotype, positively changing disease outcome and therefore, achieving a therapeutic goal. A prospective study is needed for confirmation of this finding.