Summary Background Proactive therapeutic drug monitoring (proactive‐TDM) to optimise maintenance infliximab (IFX) trough levels prior to loss of response reduces the risk of treatment failure, inflammatory bowel disease (IBD)‐related surgery and hospitalisation when compared with reactive monitoring (reactive‐TDM). Aim The aim of this study is to investigate if proactive‐TDM in a virtual biologic clinic (VBC) improves patient disease control determined by number of hospital admissions, surgeries, patient reported outcome measures (PROMs) and biomarkers of disease activity. Methods We conducted a single‐centre retrospective observational study. Data were collected from commencement of the VBC in June 2016 to September 2017. All IBD patients on IFX in the VBC were included. PROMs were recorded using the IBD‐Control‐8 sub‐score and Visual Analogue Scale. Results One hundred and twenty‐three patients were included in the study. A statistically significant improvement in faecal calprotectin was observed with proactive‐TDM with a P‐value <.001. There was a 59% reduction in crisis IBD admissions with the introduction of proactive‐TDM in the VBC (P‐value <.005). Dose de‐escalations in the first 3 months of the VBC lead to cost savings of €32 000 per annum. Conclusions The introduction of proactive‐TDM resulted in a significant reduction in hospital admissions, an increase in mean IFX trough levels, a significant improvement in faecal calprotectin and adjustment to therapy in 33% of patients. Proactive‐TDM in the setting of a VBC is a method of managing IBD patients on IFX therapy with the potential for significant cost savings.

Background Increased familiarity with capsule endoscopy (CE) has been associated with a growing demand for urgent inpatient procedures. Limited data exists comparing the effect of admission status on colon capsule (CCE) and pan-intestinal capsule (PIC) performance. We aimed to compare the quality of inpatient versus outpatient CCE and PIC studies. Methods A retrospective nested case-control study. Patients were identified from a CE database. PillCam Colon 2 Capsules with standard bowel preparation and booster regimen were used in all studies. Basic demographics and key outcome measures were documented from procedure reports and hospital patient records, and compared between groups. Results 105 subjects were included, 35 cases and 70 controls. Cases were older, were more frequently referred with active bleeding and had more PICs. The diagnostic yield was high at 77% and was similar in both groups. Completion rates were significantly better for outpatients, 43% (n = 15) v’s 71% (n = 50), OR 3, NN3. Neither gender nor age affected completion rates. Completion rates and preparation quality were similar for CCE and PIC inpatient procedures. Conclusion Inpatient CCE and PIC have a clinical role. There is an increased risk of incomplete transit in inpatients, and strategies to mitigate against this are needed.

BackgroundCapsule endoscopy is now the accepted first line investigation for suspected small bowel (SB) bleeding. Recent evidence suggests the diagnostic yield for SB pathology may be higher for tailored double headed (DH) SB capsules. Whether other forms of bidirectional capsules offer a similar advantage is less clear.AimTo compare the efficacy of single headed versus bidirectional capsules in detecting pathology in patients with suspected small bowel bleeding.MethodsA single centre prospective comparison study was conducted over an 8 month period in a tertiary care hospital. Patients referred with overt or suspected SB bleeding were assigned to either SB3 Medtronic SB capsule (SH) during the initial four months or PillCam Colon 2 Medtronic capsule (DH) during the subsequent four months. Studies were analysed by trained Capsule Endoscopists and approved by our institutions capsule review board. Findings were compared between SH and DH capsules using a chi2 or t-test as appropriate. A p value of &lt;0.05 was considered significant.Results201 subjects were included, mean age 61.8 years, 90 (45%) male. Majority referred with occult bleeding, 153 (76%). DH and SH capsule used in 100 and 101 cases, respectively. 90% (n=181) capsules were complete and overall diagnostic yield was 57% (n=114). Diagnostic yield was similar between both groups - DH 53% (n=53), SH 60% (n=61). Positive finding in overt bleeding; SH 85% (n=22) versus DH 50% (n=11), p&lt;0.02. SH capsules more frequently detected SB inflammation, 27 (27%) versus 9 (9%), p&lt;0.002. More patients had another diagnosis in the DH (19) than the SH (9), p&lt;0.04, the majority were type 1a vascular lesions, “red spots” or diminutive colonic polyps.ConclusionSingle head and double head capsules perform similary in terms of diagnostic yield overall. This supports the continued use of standard small bowel capsules for investigation of the small bowel.

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