PTU-128 Double-headed capsule endoscopy: real-world experience from a multicentre British study

Introduction:
Capsule endoscopy (CE) is a well-established mode of investigation for small bowel (SB) pathology. This study examines the potential benefits of using double-headed capsules compared to conventional single-headed ones in a real-world cohort of patients referred for CE. We present results from the first multicentre British study.
Methods:
Over a 9-month period, patients referred for routine SBCE at 4 tertiary referral centres in the UK underwent double-headed CE in lieu of conventional single-headed CE using MiroCam MC2000 capsules. CE was carried out as per local protocols. Clinical data were anonymised. One head (L/R) was chosen at random and reported by an expert reviewer. The double-headed recordings, also anonymised and randomised, were reported by another expert reviewer or re-read after a 4-week interval. For each CE, numbers and types of findings and overall conclusion/diagnosis were compared between single and double-headed examinations.
Results:
211 CE examinations were performed. 7 failed to reach the SB; 204 cases were analysed. Indications were SB bleeding (n=94); ?SB inflammation or reassessment of known inflammatory bowel disease (IBD) (n=84); ?SB neoplasia including suspicious radiological imaging (n=15) and others such as ?coeliac disease (n=11).
For SB bleeding: 27/94 (28.7%) examinations reported differences between single and double-headed readings. In 17 (18.1%) the findings were clinically significant. Single-headed CE missed angioectasias (5 pts), SB inflammation (7 pts), oesophagitis (2 pts) and SB masses (2 pts). In 1 patient the extent of angioectasias seen was greater on the double-headed reading.
In patients referred for IBD: Findings differed in 30/84 (35.7%) of CE examinations; 11 (13.1%) were clinically significant. In 5, signs of active inflammation were missed by the single-headed reading. In 6, assessment of extent/severity differed.
For ?SB neoplasia: Findings differed in 2/15 (13.3%) of examinations. Both were clinically significant.
Others: 1/11 (9.1%) of examinations differed; however this difference was not deemed clinically significant.
Overall, use of two CE heads impacted the diagnosis in 30/204 (14.7%) of cases in our cohort.
Conclusions:
The use of double-headed CE provides more information which has the potential to change clinical diagnosis and therefore management. The routine adoption of double-headed CE in SB assessment should be considered.