Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan.
Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
Dig Dis Sci. 2018 Mar;63(3):768-774. doi: 10.1007/s10620-018-4942-6. Epub 2018 Jan 29.
In order to optimize postoperative therapy in patients with Crohn's disease (CD), it is important to detect endoscopic recurrence preceding clinical recurrence. However, we have little knowledge about how high the rate of residual lesions is and whether these lesions have an influence on postoperative course or not.
To assess residual lesions in small bowel immediately after surgery.
Capsule endoscopy (CE) was performed immediately after surgery (< 3 months), and endoscopic activity was assessed using the Lewis score (LS) composed of the highest tertile score (in first, second, and third tertile) and the stenosis score (in whole small intestine). The relationship between these residual lesions and postoperative clinical recurrence was prospectively evaluated.
After assessing patency using a patency capsule, CE was performed in 25 patients. The mean LS was 751.3, and 84.0% (21/25) had endoscopic activity. These lesions were detected by preoperative examinations in 0% and by a serosal side view during surgery in 16.0%. Regarding the cumulative clinical recurrence rate according to endoscopic severity (normal, mild, and moderate-to-severe) immediately after surgery, no significant difference was found. However, comparing groups divided according to the highest tertile score, the cumulative clinical recurrence rate was significantly higher in the group with the highest third tertile score. Furthermore, patients with ulcers in the third tertile had a significantly higher recurrence rate.
Many cases with CD had endoscopic activity immediately after "curative" surgery. These residual lesions, especially in the distal small intestine, were associated with postoperative clinical recurrence.
为了优化克罗恩病（CD）患者的术后治疗，重要的是要在临床复发之前检测到内镜下的复发。然而，我们对残留病变的发生率以及这些病变是否会对术后病程产生影响知之甚少。
评估术后小肠内的残留病变。
术后（<3 个月）立即进行胶囊内镜（CE）检查，使用由最高分（第 1、2 和第 3 三分位数）和狭窄评分（整个小肠）组成的 Lewis 评分（LS）评估内镜活动。前瞻性评估这些残留病变与术后临床复发之间的关系。
在使用通畅胶囊评估通畅性后，对 25 例患者进行了 CE 检查。平均 LS 为 751.3，84.0%（21/25）存在内镜活动。这些病变在术前检查中为 0%，在术中浆膜侧视图中为 16.0%被发现。根据术后即刻内镜严重程度（正常、轻度和中重度）的累积临床复发率，没有发现显著差异。然而，根据最高三分位评分将患者分为两组，最高三分位评分组的累积临床复发率明显更高。此外，第三三分位有溃疡的患者复发率明显更高。
许多 CD 患者在“治愈性”手术后仍存在内镜活动。这些残留病变，尤其是在小肠远端，与术后临床复发有关。
