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.

中文翻译：

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胶囊内镜对预防克罗恩病术后复发的影响

背景和目标

胶囊内窥镜检查（CE）可以检测出克罗恩病（CD）术后患者的回肠结肠镜检查范围之外的病变。然而，这些发现对患者预后的影响仍然未知。这项研究旨在评估无回肠结肠切除后无药理预防的无症状CD患者的CE检查对临床管理和预后的影响。

方法

在这项回顾性队列研究中，有37例患者（第1组）在术后1年内接受了结肠镜检查和CE，而46例患者（第2组）仅接受了结肠镜检查。通过回肠结肠镜检查或CE检出的内镜复发患者接受了硫唑嘌呤或英夫利昔单抗的药物治疗。一年后，对疾病活动进行了重新评估。

结果

在第1组中，所有经回肠结肠镜检查确定的复发患者也有CE鉴别的复发。此外，CE在11例因结肠镜检查漏诊的患者中发现了内镜复发。CE证实了通过回肠结肠镜检查确定的内窥镜检查缓解率，共13例患者。一年后，所有24例患者均通过回肠结肠镜检查确定的内镜缓解得以维持，无一例临床复发。相反，在第2组中，经结肠镜检查确定的缓解率的人群中，在1年后的31例患者中有9例同时发生了经结肠镜检查确定的复发率和临床复发率。第一组的总临床复发率为2.7％（1/37），而第二组的总临床复发率为21.7％（10/46）（P = .019）。

结论

如果CE证实了通过回肠结肠镜检查确定的内镜缓解，则患者可以继续进行药理预防。如果通过CE检测到超出了结肠镜检查范围的复发，则需要开始积极的药物治疗。