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IntroductionNICE and BSG have recommended the use of faecal calprotectin (FCP) in investigating patients with suspected small bowel Crohn’s disease (SBCD). There is currently inadequate data to advise on management for intermediate ranges of FCP of 50 ug/g to 250 ug/g. This study aims to assess whether this intermediate FCP level is clinically significant for diagnosing active SBCD.MethodWe analysed patients with suspected SBCD at Hereford County Hospital from 2013–2016 who underwent SB imaging and FCP testing. Patient’s notes, laboratory results and clinical imaging were reviewed and Fisher’s exact test was used for statistical analysis.Results48 patients underwent FCP with small bowel cross-sectional imaging. For those with an elevated FCP >250 ug/g, there was a positive predictive value of 75% for diagnosing SBCD and a negative predictive value of 70% for those with an FCP <50 ug/g (p=0.02). 10 patients had an intermediate range between 50–250 ug/g of which 70% (n=7) were diagnosed with CD. See Table 1 for full details.Abstract PTU-130 Table 1Determining SBCD in relation to FCP resultsActive SBCDActive SBCD excludedPositive FCP>250217Intermediate range 50–25073Negative FCP<5037Of the three patients in the intermediate range who had normal scans, 1 patient had an FCP of 63 which then rose to 173. Although the CTE was normal, the colonoscopy showed mild erythema in the caecum. Subsequent biopsies were normal. A further OGD and USS abdomen were normal. This patient was diagnosed with non-ulcer dyspepsia and irritable bowel syndrome. Patient 2 had an FCP of 86 who was under the care of surgeons for previous adhesiolysis secondary to hysterectomy. A CTE was negative and a colonoscopy only showed haemorrhoids. Patient 3 has known SBCD with previous right hemi-colectomy. The FCP was 238 and CTE showed a narrowing of the anastomosis at the terminal ileum. Colonoscopy confirmed a non-inflammatory stricture that required dilatation.ConclusionDespite a small sample size, our study suggests that an intermediate FCP level of 50–250 ug/g has a PPV equivalent to FCP >250 ug/g and should therefore be considered as a significant finding.Disclosure of InterestNone Declared

IntroductionColonoscopy is the gold standard for evaluation of mucosal inflammation. However, CTE and MRE are now being considered as the initial investigation for small bowel Crohn’s disease (SBCD) to assess beyond the terminal ileum. This study aimed to assess the accuracy of diagnosing and staging SBCD with cross-sectional imaging and correlating the findings with faecal calprotectin (FCP).MethodWe analysed patients with suspected SBCD at Hereford County Hospital from 2013–2016. Inclusion criteria were patients who had a CTE or MRE with a recent FCP. Patient’s notes, laboratory results and clinical imaging were reviewed and analysed. An FCP >50 ug/g was considered as a positive result.Results48 patients underwent FCP and cross-sectional small bowel imaging. CTE was used in 34 patients versus 14 for MRE. Patients who underwent CTE had a PPV and NPV of 50% for SBCD. Patients who underwent an MRE had a PPV of 70% and a NPV of 100% for SBCD. The use of FCP and MRE gave a sensitivity of 100% and a specificity of 57%. See tables 1 and 2 for more detailed results.Abstract PTU-131 Table 1FCP correlation with CTE (n=34)Positive scanNegative scanNegative scan but positive colonoscopyPositive FCP14146Negative FCP330We further analysed patients with positive FCP but negative imaging results by investigating their recent colonoscopy findings. In the 6 patients who had a positive colonoscopy but normal CTE, 2 patients did not have contrast given thus they were poor quality images. 2 patients had a CTE after treatment with steroids and infliximab had started. 1 patient had mucopurulent exudate on colonoscopy, however biopsies were normal and a repeat FCP was normal. The last patient had a CTE which showed narrowing of anastomosis at TI which was shown to be a stricture on colonoscopy. Of those patients with a positive FCP but a normal scan and colonoscopy, 2 patients were diagnosed with bile salt malabsorption, 1 amoebic dysentery, 1 recurrent pharyngitis, 1 non-ulcer dyspepsia and 1 patient had a CTE after steroids were started.Abstract PTU-131 Table 2FCP correlation with MRE (n=14)Positive scanNegative scanNegative scan but positive colonoscopyPositive FCP731Negative FCP041The patient with a positive FCP and normal MRE was found to have mild erythema on colonoscopy. The other two patients with a positive FCP but normal findings thus far are still being investigated for their repeatedly elevated FCP. The patient with negative FCP and normal MRE had a colonoscopy showing patchy granularity and mucopurulent exudate in TI, however biopsies were normal.ConclusionIn our study, MRE gave a higher sensitivity for FCP and active SBCD. CTE gave a low PPV with a high false negative rate, which was subsequently correctly identified on colonoscopy. These results suggest that MRE is the cross-sectional imaging modality of choice for SBCD.Disclosure of InterestNone Declared