IBD Center, Division of Gastroenterology, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.
Department of Clinical and Experimental Medical Sciences, University of Udine School of Medicine, Udine, Italy.
Inflamm Bowel Dis. 2018 Jun 8;24(7):1566-1574. doi: 10.1093/ibd/izy048.
In Crohn's disease (CD) a small bowel study-in addition to colonoscopy-is considered necessary for diagnosis/staging. In this study we re-examined the role of capsule endoscopy (CE), colonoscopy, imaging tests [magnetic resonance enterography/computed tomographic enterography (MRE/CTE)], and inflammatory markers [fecal lactoferrin and C-reactive protein (FL/CRP)] in CD patients who had undergone intestinal resection and in those who never had surgery.
In this retrospective study 43 consecutive patients underwent CE because of staging/symptoms unexplained by colonoscopy/imaging. We compared colonoscopy, imaging, and FL/CRP with CE and evaluated the impact of the latter on clinical management and outcomes.
In patients who never had surgery imaging was negative with a positive CE in 8/15 (53%) of cases. Colonoscopy was insufficient for disease staging in 10/20 (50%) cases. CRP and FL were normal with a positive CE in 35% and 28% of cases, respectively. CE findings changed the management in 6/20 (30%) of cases, with 83% showing clinical/biochemical improvement after up to 15 months of follow-up. In postoperative patients CE was positive with negative imaging in 6/8 (75%) cases. Colonoscopy was insufficient for disease staging in 13/22 (59%) cases. CRP and FL were normal in 42% and 31.8% of patients with positive CE. In these patients CE findings changed the management in 12/23 (52%) cases with 83% of them showing clinical/biochemical improvement after up to 18 months of follow-up.
Omitting CE from diagnostic/staging algorithms in CD tends to underdiagnose clinically significant small bowel lesions, thus impacting on patients' management and outcomes. 10.1093/ibd/izy048_video1izy048.video15794820403001.
在克罗恩病（CD）中，除结肠镜检查外，小肠研究被认为对诊断/分期是必要的。在这项研究中，我们重新检查了胶囊内镜（CE）、结肠镜检查、影像学检查[磁共振肠成像/计算机断层肠成像（MRE/CTE）]和炎症标志物[粪便乳铁蛋白和 C 反应蛋白（FL/CRP）]在接受肠道切除术的 CD 患者和从未接受过手术的患者中的作用。
在这项回顾性研究中，43 例连续患者因结肠镜检查/影像学检查无法解释的症状/分期而行 CE。我们比较了结肠镜检查、影像学检查和 FL/CRP 与 CE，并评估了后者对临床管理和结果的影响。
在从未接受过手术的患者中，8/15（53%）例影像学检查为阴性，CE 为阳性。10/20（50%）例结肠镜检查不足以进行疾病分期。CRP 和 FL 正常，CE 阳性率分别为 35%和 28%。CE 检查结果改变了 6/20（30%）例患者的治疗方案，在 15 个月的随访中，83%的患者显示出临床/生化改善。在术后患者中，6/8（75%）例 CE 阳性，影像学检查为阴性。13/22（59%）例结肠镜检查不足以进行疾病分期。CRP 和 FL 正常的患者中，CE 阳性率分别为 42%和 31.8%。在这些患者中，CE 检查结果改变了 12/23（52%）例患者的治疗方案，83%的患者在 18 个月的随访中显示出临床/生化改善。
在 CD 的诊断/分期算法中省略 CE 往往会漏诊具有临床意义的小肠病变，从而影响患者的管理和结果。
