*Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; and †Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan.
Inflamm Bowel Dis. 2017 Dec;23(12):2097-2103. doi: 10.1097/MIB.0000000000001175.
Patients with Crohn's disease (CD) with small bowel strictures are at risk of surgery. Double-balloon enteroscopy (DBE) can evaluate the status of the small intestine, and retrograde contrast through the scope enables the surgeon to obtain information beyond the reach of the scope. This study aimed to examine whether a retrograde contrast study through DBE could be used as a predictor of subsequent surgery in patients with CD with small intestinal strictures.
The findings of DBE with retrograde contrast in 48 patients CD with small bowel strictures were examined.
Of the 48 patients, 14 (29%) underwent surgery for small intestinal strictures during a median observation period of 2.4 years (interquartile range: 1.4-3.7 yr). According to the results of the multivariate analysis, a maximum length of strictures ≥20 mm and the ratio of the maximum diameter of prestenotic dilations to the diameter of the normal small intestine ≥1.4 were independent risk factors of surgery for small intestinal strictures (risk ratio = 7.6 [95% confidence interval, 1.8-42.0], P = 0.006; and risk ratio = 52.0 [95% confidence interval, 3.5-2485.1], P = 0.002, respectively). The latter predicted subsequent surgery with 92% sensitivity and 88% specificity. Cumulative surgery-free rates were discriminated significantly according to the presence or absence of these 2 risk factors (log-rank test: P < 0.001).
Findings of retrograde contrast through DBE are helpful to predict risk of surgery in patients with CD with small intestinal strictures.
患有小肠狭窄的克罗恩病（CD）患者有手术风险。双气囊小肠镜（DBE）可评估小肠的状况，通过内镜逆行对比造影可以使外科医生获得超出内镜范围的信息。本研究旨在检查 CD 合并小肠狭窄患者通过 DBE 逆行对比造影能否作为预测后续手术的指标。
对 48 例小肠狭窄的 CD 患者的 DBE 逆行对比造影结果进行检查。
在中位观察期 2.4 年（四分位间距：1.4-3.7 年）内，48 例患者中有 14 例（29%）因小肠狭窄而行手术治疗。多变量分析结果显示，狭窄最大长度≥20mm 和预扩张狭窄最大直径与正常小肠直径之比≥1.4 是小肠狭窄手术的独立危险因素（风险比=7.6 [95%置信区间，1.8-42.0]，P=0.006；风险比=52.0 [95%置信区间，3.5-2485.1]，P=0.002）。后者以 92%的敏感性和 88%的特异性预测后续手术。根据是否存在这 2 个危险因素，累积无手术生存率有显著差异（对数秩检验：P＜0.001）。
DBE 逆行对比造影的结果有助于预测 CD 合并小肠狭窄患者的手术风险。
