Abstract Background The terminal ileum (TI) stands out as the most frequently affected segment of the gastrointestinal tract in Crohn’s disease (CD). Assessing mucosal inflammation only in the TI by ileocolonoscopy (IC) may lead to underestimating the overall ileal involvement. Small bowel capsule endoscopy (SBCE) offers a complete examination of the ileal segment. There is scarce and indirect data in the literature comparing both modalities in ileal disease measurement, suggesting a strong correlation. We aimed to explore the differences in activity grading between both modalities. Methods We retrospectively recruited patients with ileal CD who had undergone IC and SBCE with a maximum time interval of 4 months. For the main analysis, a required sample size of 204 patients with complete explorations was calculated. Image 1 shows the collected endoscopic scores for activity assessment. Correlation between both endoscopic scores and clinical symptoms, as well as CRP and faecal calprotectin, was performed. We also explored the value of SBCE for evaluating the terminal ileum. We collected safety data and whether the therapeutic approach changed based on SBCE results, in contrast to IC results. Results 223 patients were recruited. 174 patients were included in the main analysis because of missing data or incomplete procedures in the remaining patients. Both scores showed a moderate correlation (⍴ 0.46 95% CI, 0.39-0.6, p 0.001), and SBCE detected moderate to severe activity in more patients than IC (40 (23%) vs 10 (6%), p 0.001). Furthermore, 34 (20%) of patients with null or mild activity in IC had moderate-to-severe activity in SBCE. SBCE detected ileal traversed stenosis in more patients than IC (21 (12%) vs 3 (2%), p 0.001). The median time of follow-up after examinations was 2 1.1 - 5.1 years, and SBCE led to a change in therapeutic management compared with IC in 42 (24%) of the patients. Regarding patients with incomplete procedures, there were only 5 cases (0.05%) of SBCE retention in intestinal strictures, one of which required surgical removal. No correlation between endoscopic scores and clinical or biochemical markers was observed. Conclusion The correlation between IC and SBCE was markedly lower than reported in the literature for ileal CD activity measurement, despite not reaching the calculated sample size. SBCE was much more sensitive than IC for detecting moderate-to-severe activity and stenosing patterns in ileal CD. References: 1. Samuel S, Bruning D, Loftus EV Jr, et al. Endoscopic skipping of the distal terminal ileum in Crohn’s disease can lead to negative results from ileocolonoscopy. Clin Gastroenterol Hepatol. 2012;10(11):1253-1259. 2. Brodersen JB, Kjeldsen J, Knudsen T, Jensen MD. Endoscopic severity and classification of lesions with pan-enteric capsule endoscopy and ileocolonoscopy in ileocolonic Crohn’s disease. Endosc Int Open. 2023;11(1):E32–E38. 3. Melmed GY, Dubinsky MC, et al. Utility of video capsule endoscopy for longitudinal monitoring of Crohn’s disease activity in the small bowel: a prospective study. Gastrointest Endosc. 2018;88(6):947-955. Conflict of interest: Dr. Marquès-Camí, Miquel: I have served as speaker, consultant for or have received education funding from AbbVie, Johnson and Johnson, Lilly, Adacyte, GSK, Takeda, Kern Pharma, Ferring, and Tillots Pharma. Vergés, Laia: No conflict of interest Elosua Gonzalez, Alfonso: I have served as speaker, consultant for or have received education funding from AbbVie, Johnson and Johnson, Adacyte, Takeda, Faes Farma, and Tillots Pharma. Huguet, José María: No conflict of interest Caballero Mateos, Antonio M: has received fees for lectures, consultancy work, or research support from: Lilly, Abbvie, Johnson & Johnson, Takeda, Pfizer, Alfasigma, Ferring, Farmasierra, Kern. Caravaca, Celia: No conflict of interest Garcia De La Filia Molina, Irene: No conflict of interest Suárez, Cristina: No conflict of interest Carballo-Folgoso, Lorena: No conflict of interest Gonzalez Vivo, Maria: M González-Vivó has received support for conference attendance, speaker fees and research support from AbbVie, Ferring, Janssen, Pfizer, Takeda and Tillotts. Polo Cuadro, Cristina: No conflict of interest Torres Vicente, Gisela: No conflict of interest Lopez Martin, Maria Del Carmen: No conflict of interest Roig Ramos, Cristina: CR has received support for conference attendance and education funding from Kern Pharma, Ferring, Alfasigma, Faes Farma, Pfizer and Takeda. Velayos Jimenez, Benito: No conflict of interest Fernandez Clotet, Agnes: No conflict of interest Tejido Sandoval, Coral: Has received support for congress and conference attendance from Abbvie, Ferring, Johnson & Johnson, Pfizer, Takeda, Tillots Pharma, Dr Falk Pharma and FAES. Has received speaker fees from Johnson & Johnson. Moreno Torres, Violeta: No conflict of interest Carballal Intriago, Alfonso: No conflict of interest Brunet, Eduard: I have served as a speaker and consultant for Janssen and Chiesi, Kern, Takeda and Alfasigma. Martín, Jesús: No conflict of interest Tardillo Marin, Carlos Alberto: No conflict of interest Torrealba Medina, Leyanira: No conflict of interest Moralejo Lozano, Óscar: I have received educational funding from Abbvie, Johnson & Johnson, Takeda, Kern Pharma, Alfasigma, Pfizer, Lilly, Sandoz, Dr. Falk Pharma, Ferring, and Tillotts. I have also served as a speaker for Abbvie, Takeda, Alfasigma, and Lilly. Mínguez, Alejandro: No conflict of interest Madero Velázquez, Lucía: No conflict of interest Calafat Sard, Margalida: Personal Fees: Advisory fees for Gilead Other: I have served as a speaker, or has received research or education funding for Takeda, Janssen, Faes Farma, Falk Pharma, Kern, Pfizer and MSD. Zabana, Yamile: Personal Fees: AbbVie, Adacyte Therapeutics, Alfa-Sigma, Amgen, Boehringer Ingelheim, Dr Falk Pharma, FAES Pharma, Fresenius Kabi, Ferring, Galapagos, Janssen-J & J, Kern Pharma, Lilly, MSD, Pfizer, Sanofi, Sandoz, Takeda, Tillots Pharma Non-financial Support: Shire, Otsuka, Almirall
Cami et al. (Thu,) studied this question.