Significance of endoscopic deep small bowel evaluation using balloon-assisted enteroscopy for Crohn's disease in clinical remission.

Abstract

BACKGROUND:

Small bowel lesions of Crohn's disease (CD) are known to be associated with a poor prognosis; however, endoscopic healing leads to favorable patients' outcome. The aim of this study was to clarify the clinical impact of assessing deep small bowel lesions (DSB) using balloon-assisted enteroscopy (BAE) on CD patients in clinical remission.

METHODS:

From January 2012 to July 2018, a total of 100 CD patients in clinical remission were enrolled to undergo trans-anal enteroscopy using single-balloon enteroscope. Endoscopic evaluations at the terminal ileum (TI) were performed using a partial Simple Endoscopic Score for CD (pSES-CD). Endoscopic evaluations at the DSB used a modified partial SES-CD (mpSES-CD). We evaluated the factors associated with relapse, and the correlation of endoscopic score between the TI and DSB. For this study, relapse was defined as hospitalization within a year from enteroscopy.

RESULTS:

30 patients (30.0%) relapsed within a year from enteroscopy. Multivariate logistic regression analysis revealed that the Harvey-Bradshaw Index (OR 1.77, 95% CI 1.18-2.65; p = 0.003) and an mpSES-CD at DSB (OR 3.10, 95% CI 1.86-5.15; p = 0.001) were independent predictors for relapse, whereas a SES-CD at the TI did not exhibit independence. There was a significant correlation trend between the relapse rate and greater than 5 points of an mpSES-CD at DSB; however, there was no correlation between the relapse rate and pSES-CD at the TI.

CONCLUSION:

Even when Crohn's disease is in remission, it is important to evaluate DSB using BAE to assess endoscopic mucosal healing.

• Authors: Kaoru Takabayashi, Naoki Hosoe, Motohiko Kato, Yukie Hayashi, Kosaku Nanki, Kayoko Fukuhara, Yohei Mikami, Shinta Mizuno, Tomohisa Sujino, Makoto Mutaguchi, Makoto Naganuma, Naohisa Yahagi, Haruhiko Ogata, Takanori Kanai
• Journal: Journal of gastroenterology (J Gastroenterol) Vol. 56 Issue 1 Pg. 25-33 (Jan 2021) ISSN: 1435-5922 [Electronic] Japan
• PMID: 33078323 (Publication Type: Evaluation Study, Journal Article)

Chemical References

• Anti-Inflammatory Agents
• Immunosuppressive Agents

Topics

• Adolescent
• Adult
• Anti-Inflammatory Agents (therapeutic use)
• Balloon Enteroscopy
• Combined Modality Therapy
• Crohn Disease (diagnostic imaging, pathology, therapy)
• Diet Therapy
• Female
• Follow-Up Studies
• Humans
• Ileum (diagnostic imaging, pathology)
• Immunosuppressive Agents (therapeutic use)
• Intestinal Mucosa (diagnostic imaging, pathology)
• Logistic Models
• Male
• Middle Aged
• Multivariate Analysis
• Recurrence
• Remission Induction
• Retrospective Studies
• Severity of Illness Index
• Treatment Outcome
• Wound Healing
• Young Adult