P0293 The utility of small bowel capsule endoscopy in Crohn’s Disease – a retrospective cohort study
Authors: Yeo J H , Raman K , Willaims S , Villa M , Willsmore J , Bloom S , McCartney S , Harrow P , Kabir M , Seward E , Parisi I 
Published: January 2025

Background

Small bowel capsule endoscopy (SBCE) has the highest sensitivity and specificity for identifying Crohn’s disease (CD) affecting the small bowel. The recent CURE-CD study demonstrated that proactive treatment optimisation with SBCE monitoring led to improved outcomes. [1] We performed a retrospective cohort study at a tertiary centre in the UK to evaluate the impact of SBCE in the management of Crohn’s disease.

Methods

We reviewed the capsule database from December 2021 – December 2022. 181 SBCE were performed in this time period. We included patients who were either newly diagnosed with CD following SBCE or patients with known CD undergoing SBCE as part of disease reassessment. All patients included had no/minimal changes on imaging and/or endoscopy to justify treatment initiation/escalation for ongoing symptoms. Data was extracted from their electronic health record. Correlations were analysed using Spearman’s ranked test.

Results

96 patients met the inclusion criteria. 67 patients (69.8%) with known CD underwent SBCE as part of disease reassessment and 29 patients (30.2%) were newly diagnosed with CD following SBCE. Their baseline demographics pre-SBCE are illustrated by table 1.

Small bowel visualisation was adequate in 93 (96.8%) and the median transit time for a SBCE study was 4hrs and 36 minutes. The median Lewis Score (LS) was 423. 71 (73.9%) patients had active SB Crohn’s disease (defined as a LS &gt;135). Of these, 26 (36.6%) had moderate to severe disease (LS&gt;790). There was a poor correlation between inflammatory biomarkers and symptoms of diarrhoea/abdominal pain with active CD on SBCE with none of these reaching a correlation level greater than 0.3.

The impact of SBCE on the management of patients is showed by figure 1.

47 (48.9%) had a repeat SBCE for disease reassessment with a median time of 449 days between the first and second SBCE. The median LS for the repeat SBCE was 112. There was a significant reduction in moderate-to-severe active disease at the follow-up SBCE (baseline 26/96, 27.1% to follow-up 8/47, 17%). Repeat SBCE identified more patients in remission defined as LS &lt;135 (baseline SBCE remission 25/96, 26% vs repeat SBCE remission 27/47, 57.4%, p=0.005). No cases of capsule retention occurred.

Conclusion

In a large cohort of patients with minimal/no changes on conventional investigative modalities for Crohn’s disease, SBCE led to a change in treatment in 63.5%. Repeat SBCE showed significantly higher proportion of patients in endoscopic remission. Conventional non-invasive markers of inflammation and symptoms correlated poorly with activity on SBCE further highlighting the importance for clinicians to consider SBCE in both the workup and reassessment of disease activity in patients with Crohn’s disease.

References

1.S Ben-Horin, A Lahat, B Ungar, O Ukashi, D Yablecovitch, M M Amitai, Y Haberman, L Selinger, A Talan-Asher, O Kriger-Sharabi, T Naftali, Y Ron, H Yanai, I Dotan, U Kopylov, R Eliakim, The Israeli IBD Research Nucleus (IIRN), DOP29 Capsule endoscopy-guided proactive treatment versus standard treatment of patients with quiescent Crohn’s Disease: The CURE-CD randomized controlled trial, Journal of Crohn’s and Colitis, Volume 18, Issue Supplement_1, January 2024, Pages i125–i126,