Mansuri Ishrat, Fletcher Joel G, Bruining David H, Kolbe Amy B, Fidler Jeff L, Samuel Sunil, Tung Jeanne
1 Division of Pediatric Gastroenterology and Hepatology, Mayo Clinic, 200 First St SW, Rochester, MN 55905.
2 Present address: Boston Children's Hospital, Boston, MA.
AJR Am J Roentgenol. 2017 Jun;208(6):W216-W224. doi: 10.2214/AJR.16.16575. Epub 2017 Apr 5.
Pediatric small-bowel (SB) Crohn disease (CD) may be missed if the terminal ileum (TI) appears normal at endoscopy and SB imaging is not performed. We sought to estimate the prevalence and clinical characteristics of pediatric patients with CD and endoscopic skipping of the TI-that is, pediatric patients with active SB or upper gut inflammation and an endoscopically normal TI.
This retrospective study included pediatric patients with CD who underwent both CT enterography (CTE) or MR enterography (MRE) and ileocolonoscopy within a 30-day period between July 2004 and April 2014. The physician global assessment was used as the reference standard for SB CD activity. Radiologists reviewed the CTE and MRE studies for inflammatory parameters; severity, length, and multifocality of SB inflammation; and the presence of penetrating complications.
Of 170 patients who underwent ileal intubation, the TI was macroscopically normal or showed nonspecific inflammation in 73 patients (43%). Nearly half (36/73, 49%) of the patients with normal or nonspecific findings at ileocolonoscopy had radiologically active disease with a median length of SB involvement of 20 cm (range, 1 to > 100 cm). Seventeen (47%) of these patients had multifocal SB involvement and five (14%) had penetrating complications. Overall, endoscopic TI skipping was present in 43 (59%) patients with normal or nonspecific ileocolonoscopic findings: 20 with histologic inflammation (17 with positive imaging findings), 14 with inflammation at imaging only, and nine with proximal disease (upper gut, jejunum, or proximal ileum). There were no significant differences in the clinical parameters of the patients with and those without endoscopic TI skipping.
Ileocolonoscopy may miss SB CD in pediatric patients that is due to isolated histologic, intramural, or proximal inflammation. Enterography is complementary to ileocolonoscopy in the evaluation of pediatric CD.
如果在结肠镜检查时末端回肠外观正常且未进行小肠成像，小儿小肠克罗恩病（CD）可能会被漏诊。我们试图评估患有CD且内镜检查时末端回肠跳跃的小儿患者的患病率及临床特征，即患有活动性小肠或上消化道炎症且内镜检查时末端回肠正常的小儿患者。
这项回顾性研究纳入了在2004年7月至2014年4月期间30天内同时接受了CT小肠造影（CTE）或磁共振小肠造影（MRE）以及回结肠镜检查的小儿CD患者。医生整体评估被用作小肠CD活动的参考标准。放射科医生对CTE和MRE研究进行炎症参数、小肠炎症的严重程度、长度和多灶性以及穿透性并发症的存在情况的评估。
在170例接受回肠插管的患者中，73例（43%）患者的末端回肠在宏观上正常或显示非特异性炎症。在回结肠镜检查中表现正常或非特异性的患者中，近一半（36/73，49%）有放射学上的活动性疾病，小肠受累的中位长度为20厘米（范围为1至>100厘米）。其中17例（47%）患者有多灶性小肠受累，5例（14%）有穿透性并发症。总体而言，43例（59%）回结肠镜检查结果正常或非特异性的患者存在内镜下末端回肠跳跃：20例有组织学炎症（17例影像学检查结果阳性），14例仅在影像学上有炎症，9例有近端疾病（上消化道、空肠或近端回肠）。有内镜下末端回肠跳跃和无内镜下末端回肠跳跃的患者在临床参数上无显著差异。
回结肠镜检查可能会漏诊小儿患者中由孤立的组织学、壁内或近端炎症引起的小肠CD。小肠造影在小儿CD的评估中是对回结肠镜检查的补充。
