P096 Which patients with known Crohn’s disease after an ileo-colonoscopy will benefit most from small bowel capsule endoscopy?

Abstract Background Ileo-colonoscopy with biopsies is considered the gold standard for the diagnosis and management of Crohn’s disease (CD). In contrast, the role of small bowel capsule endoscopy (SBCE) is limited currently in cases where ileo-colonoscopy and imaging techniques raise doubts on the diagnosis or cannot explain certain clinical manifestations of Crohn’s disease. The aim of our study was to determine whether there are patients with endoscopically confirmed established CD who could get additional benefit by SBCE. Methods Retrospective analysis of prospectively collected data from 6301 patients subjected to SBCE in our department from 1st March 2003 to 18th February 2021. Patients with CD diagnosed by ileo-colonoscopy or total colonoscopy only (because the ileo-caecal valve could not be intubated) prior to SBCE were included in the study and biopsies. SBCE had been performed only in patients who lacked any clinical and/or imaging (CT/MRE) evidence of bowel obstruction. The presence and extent of mucosal lesions, namely local and/or diffuse erythema, erosions and ulcers (aphthous, superficial and/or deep) throughout the small intestine, which may be difficult to identify by traditional imaging, could either explain clinical manifestations unrelated to the findings of colonoscopy or led onto reassessment of applied treatments were sought by SBCE. Results The study sample consisted of 1002 patients (males/females: 511/491, mean age ± SD: 52.6±27.3). Among these, CD had been diagnosed with colonoscopy (and not ileo-colonoscopy) in 293 (29.2%) subjects and small bowel involvement was seen in 104 (35.5%) patients. The vast majority of these patients had lesions only in the terminal ileum (n=81, 77.8%), while the remaining patients (n=23, 22.2%) had additional lesions in more proximal parts of the small bowel. Among the 709 (70.8%) patients in whom CD had been diagnosed by ileo-colonoscopy, lesions in the terminal ileum were found in 407 (57.4 %) patients; SBCE revealed more proximal lesions in 104 patients (25.5%). In the remaining 307 patients (43.3%) in whom ileo-colonoscopy did not reveal terminal ileum involvement, more proximal small bowel lesions were seen in 35 (11.4%) patients. These lesions were mainly apthoid ulcers or larger ulcers, findings that led to a change in therapeutic management in 17 patients (48.6%). Conclusion SBCE identifies more proximal small bowel lesions in a substantial number of patients with CD established by traditional endoscopic techniques. When these lesions are more severe and extensive they may lead onto re-evaluation of the personalized therapeutic strategies.

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Panenteric capsule endoscopy versus ileocolonoscopy plus magnetic resonance enterography in Crohn’s disease: a multicentre, prospective study

BMJ Open Gastroenterology ◽

10.1136/bmjgast-2019-000365 ◽

2020 ◽

Vol 7 (1) ◽

pp. e000365 ◽

Cited By ~ 1

Author(s):

David Henry Bruining ◽

Salvatore Oliva ◽

Mark R Fleisher ◽

Monika Fischer ◽

Joel G Fletcher

Keyword(s):

Crohn’S Disease ◽

Magnetic Resonance ◽

Small Bowel ◽

Crohn's Disease ◽

Capsule Endoscopy ◽

Terminal Ileum ◽

Imaging Modality ◽

Disease Diagnosis ◽

Magnetic Resonance Enterography ◽

Proximal Small Bowel

IntroductionCrohn’s disease diagnosis and monitoring remains a great clinical challenge and often requires multiple testing modalities. Assessing Crohn’s disease activity in the entire gastrointestinal (GI) tract using a panenteric capsule endoscopy (CE) system could be used as an alternative to colonoscopy and cross-sectional imaging. This study assessed the accuracy and safety of panenteric CE in Crohn’s disease as compared with ileocolonoscopy (IC) and/or magnetic resonance enterography (MRE).MethodsA prospective, multicentre study was performed in subjects with established Crohn’s disease. Individuals with proven small bowel patency underwent a standardised bowel preparation, followed by CE ingestion and IC either the same or following day. MRE, IC, and CE interpretations were performed by blinded central readers using validated scoring systems. The primary endpoint was the overall sensitivity of CE vs MRE and/or IC in Crohn’s disease subjects.ResultsStudy enrolment included 158 subjects from 21 sites in the USA, Austria, and Israel. Of those, 99 were included in the analysis. Imaging modality scores indicated none to mild inflammation in the proximal small bowel and colon, but discrepant levels of inflammation in the terminal ileum. Overall sensitivity for active enteric inflammation (CE vs MRE and/or IC) was 94% vs 100% (p=0.125) and specificity was 74% vs 22% (p=0.001). Sensitivity of CE was superior to MRE for enteric inflammation in the proximal small bowel (97% vs 71%, p=0.021), and similar to MRE and/or IC in the terminal ileum and colon (p=0.500–0.625). There were seven serious adverse advents of which three were related to the CE device.ConclusionPanenteric CE is a reliable tool for assessing Crohn’s disease mucosal activity and extent compared with more invasive methods. This study demonstrates high performance of the panenteric CE as compared to MRE and/or IC without the need for multiple tests in non-stricturing Crohn’s disease.Trial registration numberClinicalTrials.gov NCT03241368

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P202 Crohn’s disease extent and small bowel inflammatory activity: Results of a small bowel capsule endoscopy study

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.331 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S239-S240

Author(s):

I Mitselos ◽

C Lamouri ◽

V Theopistos ◽

A Kavvadias ◽

M Moutzoukis ◽

...

Keyword(s):

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Disease Activity ◽

Capsule Endoscopy ◽

Terminal Ileum ◽

Inflammatory Activity ◽

Disease Extent ◽

Upper Gi ◽

Proximal Small Bowel

Abstract Background Small bowel capsule endoscopy (SBCE) enables the direct visualisation of the entire small bowel (SB) mucosa and the application of the Lewis score allows the reliable assessment of the SB mucosal inflammatory activity in Crohn’s disease (CD) patients. The study aim was to investigate the association of disease location, extent and inflammatory activity in CD patients with the use of SBCE Methods Retrospective study of 80 consecutive patients with an established CD that underwent SBCE in the Gastroenterology Department of the University Hospital of Ioannina between January 2007 and October 2019, for the evaluation of disease extent and disease activity. Results Fifty-one patients had evidence of endoscopic disease activity. In 30 of these patients (58.8%), the disease was located in the ileum and proximal SB, whereas in 20 patients (39.2%) the disease was located solely in the terminal ileum. In one patient (2%) treated with adalimumab, the disease was located solely in the jejunum. Eight patients (15.7%) had evidence of disease activity in the upper GI. All patients with upper GI disease activity demonstrated proximal SB disease involvement. The median Lewis score in patients with proximal CD was 1350 (mean 1666.3; Std 1343) median) against 458 (mean 1548,6; Std 1751) in patients with disease located in the ileum (p = 0.10). Conclusion In our study, proximal small bowel disease involvement was present in >50% of CD patients. Upper GI involvement was associated with extensive SB disease. Patients with proximal SB CD demonstrated a higher median Lewis score compared with those with CD located solely in the terminal ileum.

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Panenteric capsule endoscopy identifies proximal small bowel disease guiding upstaging and treatment intensification in Crohn’s disease: A European multicentre observational cohort study

United European Gastroenterology Journal ◽

10.1177/2050640620948664 ◽

2020 ◽

pp. 205064062094866 ◽

Cited By ~ 1

Author(s):

Foong Way D Tai ◽

Pierre Ellul ◽

Alfonso Elosua ◽

Ignacio Fernandez-Urien ◽

Gian E Tontini ◽

...

Keyword(s):

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Capsule Endoscopy ◽

Bowel Disease ◽

Mucosal Healing ◽

Small Bowel Disease ◽

Treatment Intensification ◽

Non Invasive ◽

Proximal Small Bowel

Background Endoscopically defined mucosal healing in Crohn’s disease is associated with improved outcomes. Panenteric capsule endoscopy enables a single non-invasive assessment of small and large bowel mucosal inflammation. Aims and methods: This multicentre observational study of patients with suspected and established Crohn’s disease examined the feasibility, safety and impact on patient outcomes of panenteric capsule endoscopy in routine clinical practice. The potential role in assessment of disease severity and extent by a comparison with existing clinical and biochemical markers is examined. Results Panenteric capsule endoscopy was performed on 93 patients (71 with established and 22 with suspected Crohn’s disease). A complete examination occurred in 85% (79/93). Two cases (2.8%) of capsule retention occurred in patients with established Crohn’s disease. Panenteric capsule resulted in management change in 38.7% (36/93) patients, including 64.6% (32/48) of those with an established diagnosis whose disease was active, and all three patients with newly diagnosed Crohn’s disease. Montreal classification was upstaged in 33.8% of patients with established Crohn’s disease and mucosal healing was demonstrated in 15.5%. Proximal small bowel disease upstaged disease in 12.7% and predicted escalation of therapy (odds ratio 40.3, 95% confidence interval 3.6–450.2). Raised C-reactive protein and faecal calprotectin were poorly sensitive in detecting active disease (0.48 and 0.59 respectively). Conclusions Panenteric capsule endoscopy was feasible in routine practice and the ability to detect proximal small bowel disease may allow better estimation of prognosis and guide treatment intensification. Panenteric capsule endoscopy may be a suitable non-invasive endoscopic investigation in determining disease activity and supporting management decisions.

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P168 Isolated terminal ileitis: when capsule endoscopy is key for Crohn’s disease diagnosis

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.297 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S222-S222

Author(s):

M FREITAS ◽

T Cúrdia Gonçalves ◽

P Boal Carvalho ◽

F Dias de Castro ◽

B Rosa ◽

...

Keyword(s):

Weight Loss ◽

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Capsule Endoscopy ◽

Disease Diagnosis ◽

Inflammatory Activity ◽

Extraintestinal Manifestations ◽

Terminal Ileitis ◽

Proximal Small Bowel

Abstract Background Terminal ileitis (TI) is a common condition in clinical practice and may be associated with a wide variety of diseases, mostly Crohn’s disease (CD). Data regarding predictors of CD diagnosis in isolated TI are lacking, particularly concerning small bowel capsule endoscopy (SBCE) findings. Aim To evaluate predictive factors for CD diagnosis in patients with isolated TI detected during ileocolonoscopy, submitted to SBCE. Methods Retrospective study including consecutive patients undergoing SBCE after diagnosis of TI without colonic mucosal abnormalities on ileocolonoscopy between January 2016 and September 2019. Demographic, clinical, biochemical, endoscopic and imaging data were collected. The diagnosis of CD was based on clinical evaluation, endoscopic, histological, radiological, and/or biochemical investigations. Results One hundred and two patients with isolated ileitis on ileocolonoscopy were included. After performing SBCE, 34.3% of the patients had a diagnosis of CD. All CD diagnosed patients had positive SBCE findings. Extraintestinal manifestations (p = 0.003), weight loss (p = 0.01), abnormal imaging (p = 0.04) and positive SBCE findings (p = 0.005) were independently associated with CD diagnosis. Regarding SBCE, presence of proximal small-bowel disease (p = 0.02), diffuse findings (p = 0.002) and presence of moderate to severe inflammatory activity (Lewis Score≥790) (p < 0.001) were independently associated with CD diagnosis. Conclusion SBCE is a valuable tool that should be systematically used in patients presenting with isolated TI, since it enabled CD diagnosis in approximately one-third of patients. A diagnosis of CD should be considered when a patient with TI shows extraintestinal manifestations, weight loss, abnormal imaging and positive SBCE findings, especially proximal involvement, diffuse findings and the presence of moderate to severe inflammatory activity.

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PA.164 CAPSULE ENDOSCOPY (CE) AND PROXIMAL SMALL BOWEL (SB) LESIONS IN PATIENTS WITH CROHN'S DISEASE (CD)

Digestive and Liver Disease ◽

10.1016/s1590-8658(08)60359-x ◽

2008 ◽

Vol 40 ◽

pp. S135

Author(s):

C. Petruzziello ◽

E. Calabrese ◽

S. Onali ◽

G. Del Vecchio Blanco ◽

G. Condino ◽

...

Keyword(s):

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Capsule Endoscopy ◽

Proximal Small Bowel

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P112 CAPSULE ENDOSCOPY AND PROXIMAL SMALL BOWEL LESIONS IN PATIENTS WITH CROHN'S DISEASE

Journal of Crohn s and Colitis Supplements ◽

10.1016/s1873-9954(08)70123-x ◽

2008 ◽

Vol 2 (1) ◽

pp. 38-39

Author(s):

C. Petruzziello ◽

E. Calabrese ◽

S. Onali ◽

G. Del Vecchio Blanco ◽

G. Condino ◽

...

Keyword(s):

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Capsule Endoscopy ◽

Proximal Small Bowel

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Wireless capsule endoscopy and proximal small bowel lesions in Crohn’s disease

World Journal of Gastroenterology ◽

10.3748/wjg.v16.i26.3299 ◽

2010 ◽

Vol 16 (26) ◽

pp. 3299 ◽

Cited By ~ 26

Author(s):

Carmelina Petruzziello

Keyword(s):

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Capsule Endoscopy ◽

Wireless Capsule Endoscopy ◽

Proximal Small Bowel ◽

Wireless Capsule

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Small Bowel Crohn's Disease: An Emerging Disease Phenotype?

Digestive Diseases ◽

10.1159/000366047 ◽

2014 ◽

Vol 33 (1) ◽

pp. 42-51 ◽

Cited By ~ 9

Author(s):

Barry Hall ◽

Grainne Holleran ◽

Deirdre McNamara

Keyword(s):

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Capsule Endoscopy ◽

De Novo ◽

Mr Enterography ◽

Anatomical Location ◽

Cross Sectional ◽

Endoscopic Techniques ◽

Distinct Disease

An increasing understanding of the pathogenesis of Crohn's disease (CD), coupled with improvements in therapeutic options, has promoted the concept of stratifying patients with CD into distinct disease phenotypes according to risk. Small bowel CD, due to the numerous non-specific potential symptoms and the anatomical location of the disease, is a particularly difficult phenotype to identify. The fact that the majority of de novo strictures occur in the ileum/ileo-colonic region ensures that recognition of small bowel involvement is essential. Certainly, it is becoming increasingly recognised due to improvements in imaging and endoscopic techniques. Both CT and MR enterography appear capable of accurately diagnosing small bowel CD. Furthermore, the development of capsule endoscopy and balloon-assisted enteroscopy allow direct visualisation of the small bowel. Limited data to date would suggest that small bowel CD is a difficult entity to treat even in the current era of the ever-expanding field of biological therapies. Further long-term follow-up studies are necessary using both small bowel capsule endoscopy and cross-sectional imaging to truly assess, firstly, whether small bowel CD is more resistant to treatment and, secondly, whether it has an effect over time in terms of complications. In the future, serological and genetic tests, coupled with the aforementioned investigations, will permit early diagnosis and early treatment of small bowel CD.

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