P-178 YI Capsule Endoscopy (CE) Aids in the Diagnosis and Management of Inflammatory Bowel Disease (IBD) in Pediatric Patients

Abstract

BACKGROUND: Capsule endoscopy is a common diagnostic procedure used in the evaluation of patients with known or suspected IBD. It is a non-invasive, endoscopic technique used to visualize the small bowel, an area not reached through endoscopy or colonoscopy. Traditionally GI nurses and practitioners prepare these patients, set up the sensor leads, administer the capsule, and very often do the preliminary read of the study. METHODS: A retrospective chart review was conducted to evaluate the diagnostic yield of capsule endoscopy in patients with suspected or known IBD and its effect on diagnosis and subsequent patient management. Nineteen patients with known or suspected IBD had CE performed in the outpatient setting at the division of Pediatric Gastroenterology and Nutrition, Stony Brook Long Children's Hospital and were included in the study. Fourteen subjects were males age 7-17: 10 had Crohn's Disease (CD), 2 had Ulcerative Colitis (UC) and 1 with Indeterminate Colitis (IC). Five were females ages 10 to 17 all with CD. Data collection included IBD serology, previous radiology studies, initial diagnosis and assessment of small bowel disease location prior to and after CE. Diagnosis and disease location on completion of CE were determined. RESULTS: In this study CE resulted in a change in the extent of disease location in 8 patients. Two patients underwent CE to assess small bowel involvement prior to surgery. One had Crohn's ileitis and underwent an ileal resection after the extent of the disease was confirmed on CE. The other had UC unresponsive to medical management. The study was nondiagnostic due to poor prep quality. Despite this he subsequently underwent a colectomy. Earlier pediatric reports have demonstrated the extent of small bowel disease is better delineated by CE than by upper gastrointestinal series with small bowel follow through. Prior to the advent of CE small bowel follow through had traditionally been the diagnostic modality for the assessing the extent of small bowel involvement. CONCLUSIONS: In this study CE did not change the diagnosis; however the extent of the disease was further refined in 8 patients and resulted in stepping up therapy in 6 of 7 patients and 1 patient was referred for surgery. It was also useful as adjunctive testing prior to surgery to assess small bowel involvement. Ideal IBD candidates for CE include: patients in whom terminal ileum intubation is not feasible during colonoscopy and those with ileal disease on biopsy unresponsive to medical management. Patients with previously diagnosed Crohn's disease may be found to more extensive involvement of the small bowel. This may result in targeting and developing more effective therapies leading to improved patient outcomes. The use of GI nurses and practitioners to prescreen CE videos may be a cost effective approach to study interpretation and provides opportunity for professional growth of the scope of practice of GI nurses.