Kono Tomoaki, Hida Nobuyuki, Nogami Koji, Iimuro Masaki, Ohda Yoshio, Yokoyama Yoko, Kamikozuru Koji, Tozawa Katsuyuki, Kawai Mikio, Ogawa Tomohiro, Hori Kazutoshi, Ikeuchi Hiroki, Miwa Hiroto, Nakamura Shiro, Matsumoto Takayuki
Tomoaki Kono, Nobuyuki Hida, Koji Nogami, Masaki Iimuro, Yoshio Ohda, Yoko Yokoyama, Koji Kamikozuru, Katsuyuki Tozawa, Mikio Kawai, Tomohiro Ogawa, Kazutoshi Hori, Shiro Nakamura, Takayuki Matsumoto, Department of Lower Gastroenterology, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan.
World J Gastrointest Endosc. 2014 Mar 16;6(3):88-98. doi: 10.4253/wjge.v6.i3.88.
To clarify the usefulness of postsurgical capsule endoscopy (CE) in the diagnosis of recurrent small bowel lesions of Crohn's disease (CD).
This prospective study included 19 patients who underwent ileocolectomy or partial ileal resection for CD. CE was performed 2-3 wk after surgery to check for the presence/absence and severity of lesions remaining in the small bowel, and for any recurrence at the anastomosed area. CE was repeated 6-8 mo after surgery and the findings were compared with those obtained shortly after surgery. The Lewis score (LS) was used to evaluate any inflammatory changes of the small bowel.
One patient was excluded from analysis because of insufficient endoscopy data at the initial CE. The total LS shortly after surgery was 428.3 on average (median, 174; range, 8-4264), and was ≥ 135 (active stage) in 78% (14 of 18) of the patients. When the remaining unresected small bowel was divided into 3 equal portions according to the transition time (proximal, middle, and distal tertiles), the mean LS was 286.6, 83.0, and 146.7, respectively, without any significant difference. Ulcerous lesions in the anastomosed area were observed in 83% of all patients. In 38% of the 13 patients who could undergo CE again after 6-8 mo, the total LS was higher by ≥ 100 than that recorded shortly after surgery, thus indicating a diagnosis of endoscopic progressive recurrence.
Our pilot study suggests that CE can be used to objectively evaluate the postoperative recurrence of small bowel lesions after surgery for CD.
阐明术后胶囊内镜检查（CE）在克罗恩病（CD）复发性小肠病变诊断中的作用。
这项前瞻性研究纳入了19例因CD接受回肠结肠切除术或部分回肠切除术的患者。术后2 - 3周进行CE，以检查小肠中残留病变的有无及严重程度，以及吻合口区域有无复发。术后6 - 8个月重复进行CE，并将结果与术后不久获得的结果进行比较。采用Lewis评分（LS）评估小肠的炎症变化。
1例患者因初始CE时内镜数据不足被排除在分析之外。术后不久的总LS平均为428.3（中位数，174；范围8 - 4264），78%（18例中的14例）患者的LS≥135（活动期）。根据通过时间将剩余未切除的小肠平均分为3等份（近端、中间和远端三分位数），平均LS分别为286.6、83.0和146.7，无显著差异。83%的患者在吻合口区域观察到溃疡性病变。在6 - 8个月后能够再次进行CE的13例患者中，38%的患者总LS比术后不久记录的高≥100，表明诊断为内镜下进展性复发。
我们的初步研究表明，CE可用于客观评估CD手术后小肠病变的术后复发情况。
