Sharma Shreyak, Li Darrick K, Levine Louis J, Chaar Abdelkader, McMillan Chandler, Gaidos Jill K J, Proctor Deborah D, Al-Bawardy Badr
Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
Section of Digestive Diseases, Yale School of Medicine, New Haven, Connecticut, USA.
Crohns Colitis 360. 2023 May 31;5(3):otad032. doi: 10.1093/crocol/otad032. eCollection 2023 Jul.
Guidelines recommend performing a flexible sigmoidoscopy in patients hospitalized with acute severe ulcerative colitis (ASUC). However, it is unclear if time to sigmoidoscopy affects relevant clinical outcomes. We aimed to assess the impact of early sigmoidoscopy on clinical outcomes using a well-characterized cohort of patients with ASUC.
This is a single-center, retrospective study of all patients hospitalized with ASUC from January 1, 2012 to November 1, 2021. Early sigmoidoscopy was defined as occurring within 72 hours of admission while delayed sigmoidoscopy was defined as occurring >72 hours after admission. Primary outcomes were cumulative days of intravenous (IV) corticosteroid (CS) use, length of hospital stay, and colectomy rates. Secondary outcomes were time to infliximab (IFX) rescue and inpatient opioid medication use.
A total of 112 patients hospitalized with ASUC who underwent sigmoidoscopy were included in the analysis. Eighty-seven patients (78%) had early sigmoidoscopy and 25 (22%) had delayed sigmoidoscopy. Patients in the early sigmoidoscopy group were exposed to significantly fewer days of IV CS (4.5 vs 9.2 days; < .001), had shorter hospital stays (6.4 vs 19.3 days; < .001), and shorter time to IFX rescue (3.5 vs 6.4 days; = .004). Rates of colectomy in the early and delayed sigmoidoscopy groups were 17% versus 28%, respectively ( = .23). Longer time to sigmoidoscopy was associated with a 16% increased risk of colectomy (HR = 1.16, = .002).
In this well-characterized cohort, early sigmoidoscopy in ASUC was associated with favorable clinical outcomes. These findings highlight the benefits of early sigmoidoscopy in patients with ASUC. Larger prospective studies are needed to corroborate these findings.
指南建议对急性重症溃疡性结肠炎（ASUC）住院患者进行乙状结肠镜检查。然而，乙状结肠镜检查的时间是否会影响相关临床结局尚不清楚。我们旨在通过一组特征明确的ASUC患者评估早期乙状结肠镜检查对临床结局的影响。
这是一项对2012年1月1日至2021年11月1日期间所有ASUC住院患者的单中心回顾性研究。早期乙状结肠镜检查定义为在入院72小时内进行，而延迟乙状结肠镜检查定义为在入院72小时后进行。主要结局为静脉注射（IV）皮质类固醇（CS）的累计使用天数、住院时间和结肠切除术率。次要结局为英夫利昔单抗（IFX）抢救时间和住院期间阿片类药物使用情况。
共有112例接受乙状结肠镜检查的ASUC住院患者纳入分析。87例（78%）患者进行了早期乙状结肠镜检查，25例（22%）患者进行了延迟乙状结肠镜检查。早期乙状结肠镜检查组患者接受IV CS的天数显著减少（4.5天对9.2天；<0.001），住院时间更短（6.4天对19.3天；<0.001），IFX抢救时间更短（3.5天对6.4天；=0.004）。早期和延迟乙状结肠镜检查组的结肠切除术率分别为17%和28%（=0.23）。乙状结肠镜检查时间越长，结肠切除术风险增加16%（HR=1.16，=0.002）。
在这组特征明确的队列中，ASUC患者早期乙状结肠镜检查与良好临床结局相关。这些发现凸显了早期乙状结肠镜检查对ASUC患者的益处。需要更大规模前瞻性研究来证实这些发现。
