DOP75 Video capsule endoscopy may detect active small bowel Crohn’s disease requiring change of treatment despite unremarkable ileo-colonic anastomosis
Thurm, T.(1,2)*;Zmora, N.(1,2,3);Hirsh, A.(1,2);Deutsch, L.(1,2);Maharshak, N.(1,2);
(1)Tel-Aviv Sourasky Medical Center, Department of Gastroenterology and Liver Diseases, Tel-Aviv, Israel;(2)Tel-Aviv University, Sackler School of Medicine, Tel-Aviv, Israel;(3)Weizmann Institute of Science, Immunology Department, Rehovot, Israel;
Background
Previous studies have shown benefit in performing video capsule endoscopy (VCE) in Crohn’s disease (CD) diagnosis, especially in cases of an unremarkable ileo-colonoscopy, however data on the role of VCE in postsurgical follow-up of CD patients is lacking. We aimed to evaluate CD endoscopic activity in the small bowel (SB) of patients presenting with disease remission at the ileo-colonic anastomosis.
Methods
We retrospectively obtained data on patients with CD older than 18 years of age, who underwent ileo-colonoscopy between the dates 1/10/2012 through 31/09/2022. Patients in whom VCE was performed within 8 months of ileo-colonoscopy were eligible for analysis. Lewis and Rutgeerts scores were calculated based on VCE images and endoscopy reports, respectively. Disease remission was deemed as Rutgeerts score of i0-i1 at the ileo-colonic anastomosis, and Lewis score (LS) of<135 on VCE.
Results
A total of 1,334 ileo-colonoscopies were performed in CD patients with ileo-colonic anastomoses during the study period, of whom 31 patients (male gender 58.06%; mean age 41.77±14.19 years) were referred to VCE within 8 months of ileo-colonoscopy, (median 124.81 days). Twenty patients exhibited endoscopic remission at the anastomosis, 3 of them failed passage of a patency capsule and 17 successfully completed VCE. Only 5 patients (29.4%) had a normal LS, while 12 (70.6%) exhibited an active SB disease (LS≥135, mean 791.3±1254.9). Patients with a discrepancy between the two scores, were characterized by a shorter disease duration (P=0.011) and showed a trend towards a shorter time since surgery (P=0.06). No correlation was found between SB disease activity and concurrent medical therapy (P=0.898). Treatment modification was applied in 7 patients (41.2%) and was associated with a higher LS (biserial correlation coefficient 0.51, P=0.037).
Conclusion
Endoscopic remission at the ileo-colonic anastomosis is not an accurate indicator for CD remission in the SB, especially in a new-onset disease and soon after the surgery. VCE has an added value to ileo-colonoscopy in postsurgical follow-up and treatment adjustment in patients with CD.