D0345 - Small Bowel Capsule Endoscopy Utility in Patients With High Suspicion of Inflammatory Bowel Disease After Negative MRE/CTE

Joseph Fabrizio, BS¹, Ryan Erwin, MD², Tina Boortalary, MD², Scott Manski, MD², Raina Shivashankar, MD², Christina Tofani, MD^2
1Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; ²Thomas Jefferson University Hospital, Philadelphia, PA

Introduction: Patients with a high suspicion of inflammatory bowel disease (IBD) routinely undergo magnetic resonance enterography (MRE) and computed tomography enterography (CT)E. Video capsule endoscopy (VCE) is an additional tool used by clinicians to visualize the small bowel for IBD. How VCE is utilized by clinicians in combination with MRE/CTE is not well defined. Often, MRE and CTE are used as first line imaging techniques to assess the small bowel. In this study, we sought to assess the utility of VCE in patients being evaluated for IBD following a normal MRE and/or CTE.

Methods: We performed a retrospective review of VCE using a tertiary-care center’s PillCam database from 8/3/2018-8/18/2021. Patients undergoing VCE for the evaluation and diagnosis of IBD were included. We then reviewed these patients’ charts to investigate whether or not a MRE or CTE were performed within 1 year of VCE.

Results: The study population included 83 patients (57% female, average age 41.8 years [range 20-75 years]). Four patients underwent VCE two separate times, totaling 87 procedures. Fourteen (17%) patients underwent a MRE within 1 year (average of 120 days) prior to VCE. Of these, 5 had positive findings for active small bowel IBD and 9 had negative findings on MRE. Among those with negative MRE, reasons for subsequent VCE included follow-up assessment of known IBD (2 patients), anemia (1), ongoing symptoms concerning for IBD (4), and findings of terminal ileum pathology on colonoscopy (2). VCE showed findings of active IBD in 33% (3) of the patients with previous negative MRE.

Seven (8%) patients underwent CTE within 1 year (average of 148 days) prior to VCE. Of these, 4 patients had no evidence of active IBD on CTE. In these patients, VCE was subsequently performed for follow-up assessment of known IBD (2), findings of terminal ileum pathology on colonoscopy (1), and ongoing symptoms concerning for IBD (1). VCE showed findings of active IBD in 50% (2) of the patients with previous negative CTE.

Discussion: Although MRE and CTE are highly sensitive for small bowel IBD, VCE provides an additional method to assess for evidence of IBD in the small bowel. In this study conducted in usual clinical practice, 33% of patients with negative MRE and 50% with negative CTE still had active IBD seen on VCE. The data presented in this study supports the use of VCE when suspicion for active IBD is high despite negative cross sectional imaging results.


Disclosures:


Joseph Fabrizio, BS¹, Ryan Erwin, MD², Tina Boortalary, MD², Scott Manski, MD², Raina Shivashankar, MD², Christina Tofani, MD². D0345 - Small Bowel Capsule Endoscopy Utility in Patients With High Suspicion of Inflammatory Bowel Disease After Negative MRE/CTE, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.