P0435 Comparative analysis between capsule endoscopy and ileocolonoscopy for activity detection in ileal Crohn’s disease. Preliminary results from the CAPITER study, a multicenter study from the Young Group of GETECCU
Authors: Marquès-Camí M , Vergés L , Caballero-Mateos A M , Carvaca C , Suárez-Ferrer C , Carballo-Folgoso L , Carballal A , Roig C , Fernández-Clotet A , Moreno V , Tejido C , Brunet-Mas E , Torres G , Huguet J M , San-Román C , Benítez J M , Zabana Y 
Published: January 2025

Abstract

Background
The terminal ileum stands out as the most frequently affected segment of the gastrointestinal tract in Crohn’s disease (CD). However, ileocolonoscopy (IC) may occasionally fail to fully explore this area. Assessing inflammation activity only in the terminal ileum may lead to underestimating the overall ileal involvement. Capsule endoscopy (CE) offers a complete examination of both the entire terminal ileum and the proximal ileal segment.

Methods
This study presents the preliminary analysis of an ongoing multicenter retrospective study conducted at 16 Spanish GETECCU centres. The primary outcome was to explore the concordance for null, mild, or moderate-severe activity detection between CE in the total ileum and IC in the terminal ileum. We also investigated the correlation between both examinations. Patient inclusion criteria permitted a maximum time interval of 3 months between the two examinations. The Lewis score of the third segment of the small intestine (Lewis-3S) was used for activity measurement in CE and the SES-CD index of the terminal ileum was used for IC. Retrospective inspection of endoscopic reports for score calculation was allowed. The study also included a comparative analysis of the specific evaluation of the terminal ileum. Correlation of endoscopic scores with clinical and biochemical markers was performed. Furthermore, we collected safety data and whether the therapeutic approach changed based on CE results in contrast to IC results.

Results
Ninety-two patients with ileal CD who underwent CE and IC have been collected. Seventy-four patients were included in the main analysis because of missing data in the remaining patients. Inflammation severity was null, low and moderate-severe in 17/35/22 patients for CE and in 51/20/3 for IC, respectively. Both scores showed weak to minimum concordance (κ 0.13 [95% CI, 0.01-0.26], p=0.03). The median Lewis-3S was 409 [IQR, 164-1294] and the median SES-CD was 2 [IQR, 0-4]. A weak correlation was observed between both scores, with a potential for a moderate association (⍴ 0.38 [95% CI, 0.17-0.6], p&lt;0.0001). CE detected luminal stenosis in 16 patients, and IC only in one patient that was also detected by CE. CE was incomplete in 10 out of 92 patients (11%), with only one case of stenosis retention requiring surgical extraction. In patients who underwent CE and IC for known CD monitoring, CE guided a treatment change in 19 out of 53 patients (36%). No correlation between endoscopic scores and clinical or biochemical markers was observed.

Conclusion
In this preliminary analysis, despite the limited sample size, our findings indicate an underestimation of global ileal activity when measured by IC in comparison to CE examination.