P-193 Monitoring of Activity in Crohn's Disease by Small Bowel Capsule Endoscopy

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Abstract

Background:

Capsule endoscopy (CE) is a diagnostic technique use for easy visualization of small bowel lesions in Crohn's disease (CD) and can enhance the management of patients with this disease. However, the guidelines issued by the European Union and USA limit the indications for CE mainly due to the risk of capsule retention. Thus, CE is not recognized in the management of CD. To determine the trends in the use of this method and associated problems by investigating the actual status of CE monitoring for small bowel lesions in CD.

Methods:

We analyzed the performance of CE, safety of this technique, and changes in therapeutic intervention based on CE findings in 28 patients with CD who underwent CE several times for monitoring of small bowel lesions (mean age: 37 ± 18.6 yr, 19 male subjects, 9 with small bowel CD, 19 with small and large bowel CD, mean disease duration: 80.1 ± 115.4 mo). They were selected from among 145 CD patients who received CE from the time when national health insurance cover was approved for the patency capsule (PC) up to the end of August 2016.

Results:

At baseline (before CE), the clinical activity index (CDAI) of the 28 subjects was 135.9 ± 109, the CRP level was 1.27 ± 1.85 mg/dL, the Lewis score (LS) was 738 ± 1448, and the Capsule Endoscopy Crohn's Disease Activity Index (CECDAI) was 8.9 ± 6.9. The number of examinations performed during the observation period was 2 in each of 18 subjects and 3 or more in each of the other 10 subjects, and the duration of each examination was 439 ± 258 days. Intestinal patency was first evaluated with PC before any other test, and the results indicated that CE was feasible in all patients. However, retention of the PC in the small intestine was confirmed in 3 subjects during CE observation and they were switched to the category of not indicated for CE. In 2 of these 3 subjects, detailed examination was subsequently performed by balloon enteroscopy, and 1 subject became suitable for CE again following additional treatment. During CE monitoring, 19 of the 28 subjects received therapeutic intervention (67.9%). In these patients, CDAI was 167.9 ± 117 before intervention and 97.8 ± 87 (P = 0.0361) after intervention, while CRP was 1.82 ± 2.03 mg/dL before intervention and 0.49 ± 0.87 mg/dL after intervention (P = 0.0351). There were also changes in CE findings following therapeutic intervention; with LS and CECDAI improving from 895 ± 1586 and 11 ± 5.3 before intervention to 281 ± 786 and 5 ± 3.8 after intervention (P = 0.0175, P = 0.0008).

Conclusions:

Evaluation of intestinal patency with the PC before performing CE needs to be performed carefully. However, CE can be useful for examination of the small intestinal mucosa in suitable patients, since it is difficult to assess small bowel changes based on clinical symptoms only. CE can also be valuable for monitoring the response to treatment. We conclude that CE is safe and clinically valuable monitoring tool.

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