Trends and safety of small bowel endoscopy in Crohn's disease in Japan: a large-scale claims database analysis

Evidence on the population-level utilization and safety of balloon-assisted endoscopy (BAE) and small bowel capsule endoscopy (SBCE) for Crohn's disease in Japan is limited. We aimed to characterize trends in BAE, SBCE, and patency capsule examination, as well as adverse events (AEs).

We analyzed the Medical Data Vision claims database. Annual utilization was assessed per patient-year for the complete calendar years 2009-2021. AEs were defined by claimsbased therapeutic interventions after procedures. The association between patency capsule examination and SBCE-related AEs was assessed using generalized estimating equations (GEE) adjusted for age, sex, and calendar year.

Among 19,881 eligible patients with Crohn's disease, 4,657 BAE and 2,679 SBCE procedures were identified. Modality switching was uncommon, with 83.9% of patients with ≥2 examinations (n =1,683) undergoing the same modality at the second examination. Utilization of both modalities increased over time, and patency capsule examination before SBCE increased from 2013 to 2021. SBCE-related AEs were rare in patients with patency capsule examination compared to those without patency capsule examination (0.88% vs. 1.47%). In the main GEE analysis, patency capsule examination was not independently associated with lower odds of SBCE-related AEs (adjusted odds ratio, 0.62; 95% confidence interval, 0.28-1.37; P= 0.235), with a similar result in sensitivity analyses.

The use of BAE and SBCE has increased in Japan alongside the spread of patency capsule examination. SBCE-related AEs were uncommon overall and numerically less frequent when preceded by patency assessment.