scholarly journals P410 Which patients with established Crohn’s disease benefit most from the use of the Patency capsule test prior to small bowel capsule endoscopy?

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S417-S418
Author(s):  
A Elosua Gonzalez ◽  
M Rullan Iriarte ◽  
S Rubio Iturria ◽  
C Rodríguez Gutiérrez ◽  
M Vicuña Arregui ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Capsule Endoscopy ◽  
Bowel Disease ◽  
Inflammatory Markers ◽  
Postoperative Recurrence ◽  
Mucosal Healing ◽  
Routine Clinical Setting ◽  
Inflammatory Bowel

Abstract Background An important factor that limits a wider utilization of small bowel capsule endoscopy (SBCE) in Crohn’s Disease (CD) is the potential risk of retention. The Patency® capsule (PC) lowers the risk of SBCE retention by assessing pre-procedure intestinal patency. Our aims were to evaluate the use of PC in patients with established CD in routine clinical practice and to identify predictive factors of intestinal patency in CD patients. Methods We included all patients with CD followed in the Inflammatory Bowel Disease Unit of the Complejo Hospitalario de Navarra in which a SBCE was performed from 01/01/2008 to 31/12/2019. An intact PC excreted in its original shape within 30 hours after swallowing was considered a positive patency test. Results A total of 465 SBCE were indicated in 333 patients. In 61.9% a previous patency test with PC was performed, with significant differences in its use according to the age at diagnosis according to the Montreal classification (A1 75.9%, A2 64.8%, A3 46.1%) and behaviour (B2 81.3%, B3 80%, B1 54.2%), the indication (postoperative recurrence monitoring 87.2%, flare 65.5%, staging small bowel disease 52.4%, assessing mucosal healing 44.8%) and the presence of previous CD surgery (68.6% vs. 55.6%). In 33 cases (7%) SBCE was contraindicated due to negative patency test. Eleven SBCE were retained of the 432 procedures finally performed (incidence 2.5%; 95% CI 1.06%-4.02%). Retention occurred in 5.6% of procedures without prior PC compared to 0.4% with previous PC (p<0.001). Stricturing disease (OR 2.94; 1.31-6.58), penetrating disease (OR 3.85; 1.59-9.31) and presence of elevated inflammatory markers (OR 3.73; 1.85-7.50) were identified as independent factors associated with retention (negative PC test or SBCE retention) in the multivariate analysis. Conclusion A patency test prior to SBCE was performed in 61.9% of patients with known CD. The use of PC is associated with a lower risk of SBCE retention in a routine clinical setting. Patients with stricturing or penetrating disease or elevation of inflammatory markers have significantly higher risk of retention and would therefore benefit from a pre-SBCE PC.

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

2020 ◽  
pp. 205064062094866 ◽  
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.

Ultrasound vs Endoscopy, Surgery, or Pathology for the Diagnosis of Small Bowel Crohn’s Disease and its Complications

2019 ◽  
Vol 25 (8) ◽  
pp. 1313-1338 ◽  
Author(s):  
Natasha Bollegala ◽  
Nadia Griller ◽  
Heather Bannerman ◽  
Mohammed Habal ◽  
Geoffrey C Nguyen
Keyword(s):  
Crohn’S Disease ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Diagnostic Accuracy ◽  
Contrast Enhancement ◽  
Sensitivity And Specificity ◽  
Bowel Disease ◽  
Clinical Decision Making ◽  
Postoperative Recurrence ◽  
Mucosal Healing

Abstract Background In patients with inflammatory bowel disease, we strive to achieve mucosal healing, as this has been shown to decrease the risk of disease flares, hospitalization, and surgery. For this reason, we must use objective measures of mucosal healing to inform our clinical decision-making and can no longer rely on patient symptoms alone. Assessment of small bowel Crohn’s disease (SBCD) is particularly challenging given its lack of accessibility via standard endoscopic techniques. Ultrasound (US) represents a readily available, cost-effective, minimally invasive, radiation-free alternative for the assessment of small bowel disease. In this study, we performed a systematic review to determine the accuracy of ultrasound in diagnosing SBCD and its complications as compared with endoscopic visualization, surgery, and/or pathology. Methods We searched MEDLINE, EMBASE, and CENTRAL. Prospective cohort studies published up to March 2017 were reviewed. References meeting all eligibility criteria were assessed at the full-text level by 2 independent reviewers. Sensitivity and specificity were collected where available. Results A total of 2817 unique references were identified. Twenty-two studies were included. All studies were at low–moderate risk of bias based on the Quality Assessment of Diagnostic Accuracy Studies criteria. Transabdominal US (TAUS) yielded moderately high sensitivity and specificity for the diagnosis of SBCD and its postoperative recurrence. Detection was more accurate for severe postoperative recurrence. The diagnostic accuracy of US in stricture and abscess detection was high. Contrast enhancement improved the detection of abscess. Diagnostic detection of fistulas was of moderate accuracy. Entero-enteric fistulization and entero-mesenteric fistulization were most clearly identified. Conclusions Ultrasound can be used to diagnose SBCD in those with known or suspected Crohn’s disease. It can be used to detect postoperative recurrence and can accurately identify abscesses and fistulas, especially with the aid of contrast enhancement.

scholarly journals Capsule endoscopy in inflammatory bowel disease: when and how

2020 ◽  
Vol 18 (3) ◽  
pp. 265-274
Author(s):  
Ida Hilmi ◽  
Taku Kobayashi
Keyword(s):  
Inflammatory Bowel Disease ◽  
Small Bowel ◽  
Capsule Endoscopy ◽  
Bowel Disease ◽  
Scoring Systems ◽  
Postoperative Recurrence ◽  
Mucosal Healing ◽  
Cross Sectional ◽  
Inflammatory Bowel ◽  
Capsule Retention

Capsule endoscopy (CE) is emerging as an important investigation in inflammatory bowel disease (IBD); common types include the standard small bowel CE and colon CE. More recently, the pan-enteric CE was developed to assess the large and small bowel in patients with Crohn’s disease (CD). Emerging indications include noninvasive assessment for mucosal healing (both in the small bowel and the colon) and detection of postoperative recurrence in patients with CD. Given the increasing adoption, several CE scoring systems have been specifically developed for IBD. The greatest concern with performing CE, particularly in CD, is capsule retention, but this can be overcome by performing cross-sectional imaging such as magnetic resonance enterography and using patency capsules before performing the procedure. The development of software for automated detection of mucosal abnormalities typically seen in IBD may further increase its adoption.

scholarly journals Small-Bowel Capsule Endoscopy in Patients with Suspected Crohn's Disease—Diagnostic Value and Complications

2010 ◽  
Vol 2010 ◽  
pp. 1-7 ◽  
Author(s):  
Pedro Figueiredo ◽  
Nuno Almeida ◽  
Sandra Lopes ◽  
Gabriela Duque ◽  
Paulo Freire ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Capsule Endoscopy ◽  
Inflammatory Markers ◽  
Diagnostic Yield ◽  
Villous Atrophy ◽  
Tertiary Care ◽  
Endoscopic Findings ◽  
Capsule Retention

Background. The aim of this work was to assess the value of capsule enteroscopy in the diagnosis of patients with suspected Crohn's Disease (CD). Methods. This was a retrospective study in a single tertiary care centre involving patients undergoing capsule enteroscopy for suspected CD. Patients taking nonsteroidal anti inflammatory drugs during the thirty preceding days or with a follow-up period of less than six months were excluded. Results. Seventy eight patients were included. The endoscopic findings included mucosal breaks in 50%, ulcerated stenosis in 5%, and villous atrophy in 4%. The diagnosis of CD was established in 31 patients. The sensitivity, specificity, positive and negative predictive value of the endoscopic findings were 93%, 80%, 77%, and 94%, respectively. Capsule retention occurred in four patients (5%). The presence of ulcerated stenosis was significantly more frequent in patients with positive inflammatory markers. The diagnostic yield of capsule enteroscopy in patients with negative ileoscopy was 56%, with a diagnostic acuity of 93%. Conclusions. Small bowel capsule endoscopy is a safe and valid technique for assessing patients with suspected CD. Capsule retention is more frequent in patients with positive inflammatory markers. Patients with negative ileoscopy and suspected CD should be submitted to capsule enteroscopy.

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