Department of Gastroenterology endoscopy center, Affiliated Hospital of Nanjing University of Chinese Medicine.
Department of Pathology, Affiliated Hospital of Nanjing University of Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine.
Eur J Gastroenterol Hepatol. 2023 Oct 1;35(10):1143-1148. doi: 10.1097/MEG.0000000000002624. Epub 2023 Aug 14.
Small bowel (SB) endoscopic healing has not been well explored in patients with Crohn's disease (CD). This study aimed to assess the clinical utility of SB endoscopic mucosal and histological healing in patients with CD.
In total, 99 patients with CD in clinical-serological remission were retrospectively followed after they underwent colonoscopy and double-balloon enteroscopy. Time until clinical relapse (CD activity index of >150 with an increase of >70 points) and serological relapse (abnormal elevation of C-reactive protein levels) constituted the primary endpoints.
Of the 99 patients, 75 (74.7%) exhibited colonoscopic healing and 43 (43.4%) exhibited SB endoscopic healing. Clinical relapse, serological relapse, hospitalization, and surgery occurred in 8 (18.6%), 11 (25.6%), 11 (25.6%), and 2 (4.6%) patients, respectively. Of the 43 patients who exhibited SB endoscopic healing, 21 (48.8%) achieved histological healing. Clinical relapse, serological relapse, hospitalization, and surgery occurred in 4 (19.0%), 7 (33.3%), 7 (33.3%), and 1 (4.8%) patient, respectively. There was no statistically significant difference in the number of patients who relapsed, were hospitalized, or underwent surgery between those who exhibited histological healing and those who did not.
A substantial number of patients who were in clinical-serological remission did not undergo SB endoscopic healing, and the lesions increased their risk of clinical relapse. Thus, endoscopic healing may be of greater clinical value than histological healing when evaluating the remission of patients with CD.
尚未充分研究克罗恩病（CD）患者的小肠（SB）内镜愈合情况。本研究旨在评估 CD 患者 SB 内镜黏膜和组织学愈合的临床应用价值。
回顾性随访 99 例临床-血清学缓解的 CD 患者，他们接受了结肠镜检查和双气囊小肠镜检查。临床复发（CD 活动指数>150 且增加>70 分）和血清学复发（C 反应蛋白水平异常升高）的时间为主要终点。
99 例患者中，75 例（74.7%）结肠镜下愈合，43 例（43.4%） SB 内镜下愈合。8 例（18.6%）、11 例（25.6%）、11 例（25.6%）和 2 例（4.6%）患者分别出现临床复发、血清学复发、住院和手术。43 例 SB 内镜下愈合患者中，21 例（48.8%）达到组织学愈合。4 例（19.0%）、7 例（33.3%）、7 例（33.3%）和 1 例（4.8%）患者分别出现临床复发、血清学复发、住院和手术。组织学愈合组和未愈合组在复发、住院和手术的患者数量上无统计学差异。
大量处于临床-血清学缓解的患者并未接受 SB 内镜愈合治疗，且病变增加了临床复发的风险。因此，在评估 CD 患者的缓解情况时，内镜愈合可能比组织学愈合具有更大的临床价值。
