Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
Health Administration Center, Center for the Advancement of Higher Education, Tohoku University, Sendai, Japan.
Dig Dis Sci. 2022 Jan;67(1):263-272. doi: 10.1007/s10620-021-06841-6. Epub 2021 Jan 25.
In Crohn's disease, postoperative endoscopic activity of small bowel lesions outside the scope of ileocolonoscopy has been insufficiently studied.
We aimed to assess this postoperative activity using capsule endoscopy (CE) and analyze the association between treatment optimization based on CE findings and the long-term course.
In patients who underwent intestinal resection, we performed CE and assessed the endoscopic activity using the Lewis score within 3 months postoperatively (1st CE) and during follow-up. Postoperative treatments were adjusted according to clinical symptoms or CE findings (severity of 1st CE or worsening of follow-up CEs). Hospitalization, repeat surgery, or endoscopic dilation defined the primary outcome.
Among the CE group (N = 48), 85.7% (1st CE) and 79.2% (2nd CE) exhibited endoscopic activities indicating residual or recurrent lesions. Postoperative treatments were adjusted according to clinical symptoms in the non-CE group (N = 57) and clinical symptoms or CE findings in the CE group. Compared to the non-CE group, the CE group had significantly fewer primary outcomes. Patients with treatment adjustments based on CE findings had even lower primary outcome rate. Multivariate analysis identified the CE group as an independent protective factor (hazard ratio = 0.45, 95% confidence interval = 0.20-0.96). Treatment adjustments based on CE findings showed a stronger protective effect (0.30, 0.10-0.75).
Postoperative repeated CE enabled us to assess residual and recurrent lesions accurately before clinical symptoms appeared. The regular assessment of endoscopic activity and subsequent treatment optimization have the potential for improving postoperative course.
在克罗恩病中，经内镜肠切除术（ileocolonoscopy）范围以外的小肠病变的术后内镜活动尚未得到充分研究。
我们旨在使用胶囊内镜（CE）评估这种术后活动，并分析基于 CE 结果优化治疗与长期病程之间的关联。
在接受肠道切除术的患者中，我们在术后 3 个月内（首次 CE）和随访期间使用 Lewis 评分评估 CE 发现的内镜活动。根据临床症状或 CE 发现（首次 CE 的严重程度或随访 CE 的恶化）调整术后治疗。住院、再次手术或内镜扩张定义为主要结局。
在 CE 组（N=48）中，85.7%（首次 CE）和 79.2%（第二次 CE）表现出内镜活动，表明存在残留或复发性病变。在非 CE 组（N=57）中，根据临床症状调整术后治疗，在 CE 组中，根据临床症状或 CE 发现调整术后治疗。与非 CE 组相比，CE 组的主要结局显著减少。基于 CE 结果进行治疗调整的患者，其主要结局发生率更低。多变量分析确定 CE 组是一个独立的保护因素（危险比=0.45，95%置信区间=0.20-0.96）。基于 CE 结果进行治疗调整显示出更强的保护作用（0.30，0.10-0.75）。
术后重复 CE 使我们能够在出现临床症状之前准确评估残留和复发性病变。定期评估内镜活动和随后的治疗优化有可能改善术后病程。
