IntroductionCapsule endoscopy (CE) is increasingly being used to visualise the small intestine in patients with known or suspected Crohn’s disease. The aim of this study was to review the use of CE for this purpose over a two year period in a medium sized DGH following the creation of a new CE service.MethodsElectronic records of all patients undergoing CE between 1st April 2013 and 31st March 2015 were reviewed. Patients who underwent the procedure to investigate for possible small bowel Crohn’s disease (based on clinical, biochemical and/or endoscopic suspicion) or to assess previously diagnosed Crohn’s disease we identified. Record was also made of contemporaneous faecal calprotectin results and ileal appearances at colonoscopy.ResultsTwenty-four patients underwent CE to investigate possible small bowel Crohn’s disease. Of these, 11 (46%) had CE findings supportive of Crohn’s disease. 5 of these 11 patients had contemporaneous faecal calprotectin measurement of which 4 (80%) were positive. Eight of these 11 patients had contemporaneous ileal intubation of which 7 (88%) showed evidence of ileitis. Of the 13 patients with normal CE findings, 8 had faecal calprotectin measurement of which only 1 (12%) was positive. Eleven of the 13 patients had contemporaneous ileal intubation of which 4 (36%) showed mild ileitis.Ten patients underwent CE to assess known small bowel Crohn’s disease. CE was normal in 4 cases and showed evidence of active small bowel Crohn’s in 6 cases. Of the 4 patients with normal CE findings, 2 had faecal calprotectin measurement of which both were normal and 3 had ileal intubation which showed no evidence of inflammation in all cases. Of the 6 patients with CE findings suggestive of active small bowel Crohn’s, 5 had faecal calprotectin measurement of which 4 (80%) were normal and all 6 had ileal intubation which showed ileitis in 4 (67%).ConclusionIn patients with suspected small bowel Crohn’s disease CE findings supported this diagnosis in nearly half of patients and CE findings correlated well with faecal calprotectin measurement and ileal appearances at colonoscopy. However, in patients undergoing CE to assess known small bowel Crohn’s, CE showed active disease in 57% of patients with normal faecal calprotectin measurement although there was better correlation between CE findings and ileal appearances at colonoscopy. This suggests that CE is an informative test in both the investigation and ongoing management of small bowel Crohn’s disease, and may be a more sensitive test of small bowel Crohn’s disease than faecal calprotectin.Disclosure of InterestNone Declared

IntroductionCapsule endoscopy (CE) is increasingly being used to investigate iron deficiency anaemia (IDA) when bi-directional endoscopy does not find a cause although current guidelines do not recommend routine small intestinal investigation unless symptoms or recurrent/refractory IDA.1 The aim of this study was to review the use of CE in the investigation of IDA over a two year period in a medium sized DGH following the creation of a new CE service.MethodsElectronic records of all patients undergoing CE between 1st April 2013 and 31st March 2015 were reviewed. Indication for CE was recorded along with the result of the investigation. Clinic letters were reviewed to assess the impact of CE on patient management.ResultsOver the study period 97 CE procedures were performed. Fifty (52%) procedures were performed to investigate IDA, 34 (35%) for investigation of possible or known Crohn’s disease; 4 (4%) for polyposis and 9 (9%) for other indications.Of the 50 CE procedures for IDA, 18 (36%) showed abnormalities in the small bowel; these included polyps (28%), vascular lesions (33%) and ulcers (28%). No malignancy was found over the 2 year period although one large (3 cm) polyp exhibited high grade dysplasia. Thirteen procedures (26%) showed gastroduodenal pathology but no small bowel abnormality. There was no difference between the mean ages of patients with normal compared to abnormal small bowel CE findings (56.9 years old vs 57.6 years old).In 8 of the 18 cases (44%) where small bowel abnormalities were found there was a subsequent change in patient management; this included surgery to remove polyps, endoscopic treatment of vascular lesions and medication changes. Thirty-eight patients (76%) were discharged from clinical follow up following CE with advice to continue long-term iron supplementation; this included 8 patients with abnormalities seen at CE.ConclusionOver a third of patients undergoing CE to investigate IDA were found to have small bowel pathology. However less than half of these findings resulted in significant management changes. In total CE findings altered clinical management in only 16% of patients although it did allow 76% of patients to be discharged from further clinical follow-up. Clincal factors such as age did not appear to predict the presence of small bowel pathology. As a result, the role and timing of CE in the investigation of IDA remains uncertain.Reference1 Guidelines for the management of iron deficiency anaemia. Goddard, et al. on behalf of the British Society of Gastroenterology 2011.Disclosure of InterestNone Declared