PWE-102 Capsule endoscopy in suspected small bowel crohn’s disease-is it worth repeating a negative study?

Introduction Crohn’s disease (CD) affects the small bowel (SB)1 in a significant proportion of patients. Capsule endoscopy (CE) has a high diagnostic yield (DY) for SB CD and inflammation2; however, in patients with negative initial CE but ongoing clinical suspicion of CD, information on the utility of repeat CE is limited. Methods Using a prospectively-maintained database, we identified patients undergoing repeat CE for suspected SB CD at a tertiary care centre. Over the data collection period (2005–2017), CEs were reported based on clinical impression without use of a standardised tool (i. e. Lewis score or CECDAI). Results Over the study period, 434 CEs were carried out for suspected SB CD. 19 (4.4%) were repeat CEs, median age of patients 44.3 years (range 15.8–66.8), 14F/5M. The median time between CEs was 544 days (range 48–3123). Conclusion The DY of repeat CE carried out for suspected SB CD was 6/17 (35.3%) where there had been diagnostic uncertainty following the initial CE. In patients where no SB inflammation was seen on the initial CE, 0/5 (0%) of repeat CEs showed inflammatory changes. Although the numbers in this cohort study are small, our findings would support the hypothesis that repeat CE is useful in equivocal and inconclusive studies where there is clinical suspicion of SB CD. Conversely, in patients whose initial CE showed no evidence or suggestion of SB CD, repeating the procedure adds little.