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Impact of capsule endoscopy on prevention of postoperative recurrence of Crohn's disease.

Abstract：

BACKGROUND AND AIMS:Capsule endoscopy (CE) can detect lesions outside the scope of ileocolonoscopy in postoperative patients with Crohn's disease (CD). However, the impact of such findings on patient outcomes remains unknown. This study is intended to evaluate the impact of CE findings on clinical management and outcomes in asymptomatic patients with CD without pharmacologic prophylaxis after ileocolonic resection. METHODS:In this retrospective cohort study, 37 patients (group 1) received ileocolonoscopy together with CE within 1 year after surgery, whereas 46 patients (group 2) only received ileocolonoscopy. Patients with endoscopic recurrence detected by either ileocolonoscopy or CE received pharmacologic therapy with azathioprine or infliximab. One year later, disease activity was re-evaluated. RESULTS:In group 1, all patients with ileocolonoscopy-identified recurrence also had CE-identified recurrence. In addition, CE detected endoscopic recurrence in 11 patients missed by ileocolonoscopy. Endoscopic remission identified by ileocolonoscopy was confirmed by CE in 13 patients. One year later, endoscopic remission identified by ileocolonoscopy was maintained in all 24 patients, and none had clinical recurrence. Conversely, in group 2, of those with ileocolonoscopy-identified remission, both ileocolonoscopy-identified recurrence and clinical recurrence occurred in 9 of 31 patients 1 year later. The total clinical recurrence rate was 2.7% (1/37) in group 1 versus 21.7% (10/46) in group 2 (P = .019). CONCLUSIONS:If endoscopic remission identified by ileocolonoscopy was confirmed by CE, patients could remain free of pharmacologic prophylaxis. If recurrence outside the scope of ileocolonoscopy was detected by CE, initiation of active pharmacologic therapy would be needed.

journal_name

Gastrointest Endosc

journal_title

Gastrointestinal endoscopy

authors

Han ZM,Qiao WG,Ai XY,Li AM,Chen ZY,Feng XC,Zhang J,Wan TM,Xu ZM,Bai Y,Li MS,Liu SD,Zhi FC

doi

10.1016/j.gie.2018.01.017

subject

Has Abstract

pub_date

2018-06-01 00:00:00

pages

1489-1498

issue

6

eissn

0016-5107

issn

1097-6779

pii

S0016-5107(18)30047-6

journal_volume

87

pub_type

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