Department of Hepato-Gastroenterology and Oncology, CHRU Trousseau Tours, France.
Department of Hepato-Gastroenterology, Lyon-Sud Hospital, Hospices Civils of Lyon, Pierre-Bénite and University Claude Bernard Lyon 1, Lyon, France.
Gastrointest Endosc. 2019 Jul;90(1):151-157. doi: 10.1016/j.gie.2019.02.030. Epub 2019 Mar 5.
Confocal laser endomicroscopy (CLE) has been shown to predict relapse in inflammatory bowel disease, but its value in the detection of postoperative recurrence in Crohn's disease (CD) is unknown. The aims of this pilot study performed in patients with CD after ileocolonic resection were to compare the macroscopic appearance of the neoterminal ileum, according to the endoscopic Rutgeerts score, with the microscopic findings provided by CLE 6 to 12 months after surgery and to assess the predictive values of CLE-generated parameters for predicting further recurrence in patients with postoperative endoscopic remission.
In 25 consecutive patients with CD within 6 to 12 months of surgery, the neoterminal ileum was examined by standard white-light endoscopy (Rutgeerts scale) followed by CLE (Watson grade). Only patients without endoscopic recurrence (Rutgeerts i0 and i1) were then followed endoscopically and clinically (median follow-up 38 months).
At the time of the first postoperative colonoscopy, 18 patients (72%) were in endoscopic remission, and 7 (28%) experienced an endoscopic recurrence (Rutgeerts ≥i2). The Rutgeerts score was significantly correlated with the Watson score (ρ = 0 .73; P < .0001). The Watson scores at baseline were significantly higher in patients with further endoscopic recurrence (median 2.0; interquartile range [IQR] 1.5-2.0) than in those with endoscopic remission (median 1.0; IQR 1.0-1.0; P = .032) and were significantly higher in patients with clinical relapse (medium 2.0, IQR 2.0-2.0) compared with those in clinical remission (median 1.0; IQR 1.0-1.0; P = .036).
CLE could be useful in monitoring patients with CD after intestinal resection. Further studies with a larger population are necessary to confirm these preliminary results.
共聚焦激光内镜检查（CLE）已被证明可预测炎症性肠病的复发，但它在克罗恩病（CD）术后复发中的价值尚不清楚。本研究旨在探讨 CLE 对 CD 患者肠切除术后的检测价值，该研究在术后 6-12 个月的 CD 患者中进行，旨在比较术后内镜缓解患者 CLE 检查发现的微观表现与术后 6-12 个月时的新末端回肠的宏观表现，同时评估 CLE 生成的参数对预测术后内镜缓解患者进一步复发的预测价值。
在 25 例术后 6-12 个月的 CD 患者中，通过标准白光内镜（Rutgeerts 评分）和 CLE（Watson 分级）检查新末端回肠。只有无内镜复发的患者（Rutgeerts i0 和 i1）接受内镜和临床随访（中位随访 38 个月）。
首次术后结肠镜检查时，18 例（72%）患者处于内镜缓解期，7 例（28%）患者内镜复发（Rutgeerts ≥i2）。Rutgeerts 评分与 Watson 评分显著相关（ρ=0.73；P<0.0001）。有进一步内镜复发的患者的基线 Watson 评分明显更高（中位数 2.0；四分位距[IQR]1.5-2.0），而内镜缓解的患者（中位数 1.0；IQR 1.0-1.0；P=0.032）和临床缓解的患者（中位数 1.0；IQR 1.0-1.0；P=0.036）的 Watson 评分明显更高。
CLE 可能有助于监测肠切除术后的 CD 患者。需要进一步的研究来证实这些初步结果。
