Hard to swallow: MBS snubs capsule endoscopy for Crohns disease

The Medical Services Advisory Committee (MSAC) has again rejected an application to list capsule endoscopy for small bowel Crohn’s disease on the MBS.

The decision relates to two proposed indications: for the diagnosis of suspected small bowel Crohn’s disease and for the assessment of patients with established isolated small bowel Crohn’s disease.

MSAC said it did not support public funding due to ‘a high degree of uncertainty regarding diagnostic accuracy’ in this patient group.

The committee was also concerned about safety, with a recent meta-analysis finding a capsule retention rate of 4%.

MSAC said evidence presented was largely retrospective and there had been no new evidence since it considered similar applications in 2011 and 2013.

However Professor Rupert Leong from the University of Sydney, told the limbic there was good evidence to support capsule endoscopy and he was disappointed with the MSAC decision.

“This is a severe phenotype. Patients typically require more aggressive treatments, end up having more surgery and are also at risk of getting short bowel syndrome because of the long lengths of bowel involved.”

“Patients are disadvantaged by it because they don’t tend to accumulate enough of a CDAI score to get a biological agent. Now we have disadvantaged them even further by not being able to diagnose them at an early stage.”

He said capsule endoscopy provided the ability to diagnose and intervene in patients at an early stage and prevent irreversible complications typical for upper gastrointestinal Crohn’s disease.

“We really do rely on a mucosal assessment that can be done safely and effectively.”

He said the only proviso was there was probably a need for the patency capsule to help avoid retention in patients who already had narrowing.

“People with established Crohn’s disease should not have the capsule without a prior investigation such as MRE or the use of a patency capsule (a dissolvable capsule that verifies adequate patency of the GI tract prior to capsule endoscopy). Some sort of pre-assessment will significantly reduce the rate of retention.”

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