Brief Article
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World J Gastrointest Endosc. Mar 16, 2014; 6(3): 88-98
Published online Mar 16, 2014. doi: 10.4253/wjge.v6.i3.88
Prospective postsurgical capsule endoscopy in patients with Crohn’s disease
Tomoaki Kono, Nobuyuki Hida, Koji Nogami, Masaki Iimuro, Yoshio Ohda, Yoko Yokoyama, Koji Kamikozuru, Katsuyuki Tozawa, Mikio Kawai, Tomohiro Ogawa, Kazutoshi Hori, Hiroki Ikeuchi, Hiroto Miwa, Shiro Nakamura, Takayuki Matsumoto
Tomoaki Kono, Nobuyuki Hida, Koji Nogami, Masaki Iimuro, Yoshio Ohda, Yoko Yokoyama, Koji Kamikozuru, Katsuyuki Tozawa, Mikio Kawai, Tomohiro Ogawa, Kazutoshi Hori, Shiro Nakamura, Takayuki Matsumoto, Department of Lower Gastroenterology, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
Hiroki Ikeuchi, Department of Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
Hiroto Miwa, Department of Upper Gastroenterology, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
Author contributions: Kono T, Hida N, Matsumoto T designed the study; Kono T, Hida N, Nogami K, Iimuro M, Ohda Y, Yokoyama Y, Kamikozuru K, Tozawa K, Ogawa T, Hori K, Nakamura S, Ikeuchi H, Miwa H performed the research; Kono T, Hida N wrote the manuscript; all authors have approved the final version to be published.
Correspondence to: Tomoaki Kono, MD, Department of Lower Gastroenterology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan. kono@hyo-med.ac.jp
Telephone: +81-798-456662 Fax: +81-798-456661
Received: November 27, 2013
Revised: February 16, 2014
Accepted: March 3, 2014
Published online: March 16, 2014
Abstract

AIM: To clarify the usefulness of postsurgical capsule endoscopy (CE) in the diagnosis of recurrent small bowel lesions of Crohn’s disease (CD).

METHODS: This prospective study included 19 patients who underwent ileocolectomy or partial ileal resection for CD. CE was performed 2-3 wk after surgery to check for the presence/absence and severity of lesions remaining in the small bowel, and for any recurrence at the anastomosed area. CE was repeated 6-8 mo after surgery and the findings were compared with those obtained shortly after surgery. The Lewis score (LS) was used to evaluate any inflammatory changes of the small bowel.

RESULTS: One patient was excluded from analysis because of insufficient endoscopy data at the initial CE. The total LS shortly after surgery was 428.3 on average (median, 174; range, 8-4264), and was ≥ 135 (active stage) in 78% (14 of 18) of the patients. When the remaining unresected small bowel was divided into 3 equal portions according to the transition time (proximal, middle, and distal tertiles), the mean LS was 286.6, 83.0, and 146.7, respectively, without any significant difference. Ulcerous lesions in the anastomosed area were observed in 83% of all patients. In 38% of the 13 patients who could undergo CE again after 6-8 mo, the total LS was higher by ≥ 100 than that recorded shortly after surgery, thus indicating a diagnosis of endoscopic progressive recurrence.

CONCLUSION: Our pilot study suggests that CE can be used to objectively evaluate the postoperative recurrence of small bowel lesions after surgery for CD.

Keywords: Crohn’s disease, Postoperative recurrence, Capsule endoscopy, Lewis score, Small bowel

Core tip: The usefulness of capsule endoscopy (CE) in diagnosing recurrent small bowel lesions after surgery for Crohn’s disease (CD) has not yet been sufficiently established. This study revealed that many inflammatory lesions were already present throughout the residual small bowel shortly after surgery for CD, thus indicating an active stage of the disease on the basis of the total Lewis score in 77.8% of the patients. We concluded that the CE findings shortly after surgery can be used as a baseline for comparison against the findings from additional CE sessions over time and that this method can be used to objectively evaluate the postoperative recurrence of small bowel lesions after surgery for CD.