PTU-010 A Combination of Pillcam®SB2 and Smartpill® in the Investigation of Patients Referred for Assessment of Known or Suspected Small-Bowel Crohn’s Disease &amp; Their Association with Faecal Calprotectin Levels; Case Series
Authors: De Yung, J Plevris, A Koulaouzidis
Journal: Gut (2016)

<h3>Introduction</h3> SmartPill® (Given Imaging Corp., Yoqneam, Israel) is an ingestible, wireless, non-imaging capsule device that records physiological data including contractions, pH and temperature throughout the gastrointestinal (GI) tract.<sup>1</sup> There are currently scarce data looking at SmartPill® assessment of patients with known or suspected small-bowel Crohn’s Disease(CD).<sup>2</sup> We designed this pilot study to investigate feasibility and safety of SmartPill® assessment of gut motility in this group (local ethics committee approval ref.12/SS/0013). <h3>Methods</h3> Over one year (2012), patients with known or suspected CD, referred for small-bowel capsule endoscopy (SBCE), were invited to participate. Patients underwent hydrogen breath test to exclude small-bowel bacterial overgrowth, patency capsule (Agile®) to confirm luminal patency and provided stool samples for faecal calprotectin (FC). Patients ingested PillCam®SB2, then SmartPill®4 h afterwards. Thirty-three healthy controls were obtained from unpublished data. For statistical analysis, <i>P</i> &lt; 0.05 was considered significant. <h3>Results</h3> Over the aforementioned period, 12 patients were recruited (7 F/5 M, mean age 44.2 ±16.6 years). 10 underwent complete SmartPill® examination (1 stomach retention, 1 dropout). Pillcam®SB2 was complete in 10 (1 stomach retention, 1 dropout). Mean FC was 340 ±307.7 μg/g. The study group had longer transit times and lower gut motility index (MI) compared to controls, where MI = Ln (sum of pressure amplitudes × number of contractions + 1). The difference in motility appears statistically significant<i> (P</i> &lt; 0.05). Transit times for SmartPill® were longer than PillCam®SB2 (not statistically significant), possibly due to differences in capsule specifications. Limitations: signal loss from SmartPill® (5/10 studies), possibly due to radiofrequency interference. <h3>Conclusion</h3> This study is the first pilot to attempt combining SBCE and SmartPill® in clinical assessment of small-bowel CD. Current data on motility in CD is scarce. Multimodal information could provide a clearer clinical picture.<sup>3–5</sup> Furthermore, despite concerns about capsule retention in CD patients, our study suggests SmartPill® appears safe for use if a patency capsule is employed beforehand. <h3>References</h3> 1 Tran K, Brun R, Kuo B. Evaluation of regional and whole gut motility using the wireless motility capsule: relevance in clinical practice. <i>Therap Adv Gastroenterol</i> 2012;<b>5</b>:249–260. 2 Rao SSC, Camilleri M, Haler WL, <i>et al</i>. Evaluation of gastrointestinal transit in clinical practice: position paper of the American and European Neurogastroenterology and Motility Societies. <i>Neurogastroenterol Motil</i> 2011;<b>23</b>:8–23. 3 Koulaouzidis A, Iakovidis DK, Karargyris A, <i>et al</i>. Wireless endoscopy in 2020: Will it still be a capsule? <i>World J Gastroenterol</i> 2015;<b>21</b>:5119–30. 4 Dignass A, Van Assche G, Lindsay JO, Lémann M, Söderholm J, <i>et al</i>. The second European evidence-based consensus on the diagnosis and management of Crohn’s disease: current management. <i>J Crohns Colitis</i> 2010;<b>4</b>:28–62. 5 Fireman Z, Mahajna E, Broide E, Shapiro M, Fich L, <i>et al</i>. Diagnosing small bowel Crohn’s disease with wireless capsule endoscopy. <i>Gut</i> 2003;<b>52</b>:390–92. <h3>Disclosure of Interest</h3> D. Yung: None Declared, J. Plevris: None Declared, A. Koulaouzidis Grant/research support from: ESGE- Given®Imaging Research grant 2011