Capsule Endoscopy Is Useful for Postoperative Tight Control Management in Patients with Crohn’s Disease

Abstract

Background

In Crohn’s disease, postoperative endoscopic activity of small bowel lesions outside the scope of ileocolonoscopy has been insufficiently studied.

Aims

We aimed to assess this postoperative activity using capsule endoscopy (CE) and analyze the association between treatment optimization based on CE findings and the long-term course.

Methods

In patients who underwent intestinal resection, we performed CE and assessed the endoscopic activity using the Lewis score within 3 months postoperatively (1st CE) and during follow-up. Postoperative treatments were adjusted according to clinical symptoms or CE findings (severity of 1st CE or worsening of follow-up CEs). Hospitalization, repeat surgery, or endoscopic dilation defined the primary outcome.

Results

Among the CE group (N = 48), 85.7% (1st CE) and 79.2% (2nd CE) exhibited endoscopic activities indicating residual or recurrent lesions. Postoperative treatments were adjusted according to clinical symptoms in the non-CE group (N = 57) and clinical symptoms or CE findings in the CE group. Compared to the non-CE group, the CE group had significantly fewer primary outcomes. Patients with treatment adjustments based on CE findings had even lower primary outcome rate. Multivariate analysis identified the CE group as an independent protective factor (hazard ratio = 0.45, 95% confidence interval = 0.20–0.96). Treatment adjustments based on CE findings showed a stronger protective effect (0.30, 0.10–0.75).

Conclusions

Postoperative repeated CE enabled us to assess residual and recurrent lesions accurately before clinical symptoms appeared. The regular assessment of endoscopic activity and subsequent treatment optimization have the potential for improving postoperative course.

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Abbreviations

CD:

Crohn’s disease

CE:

Capsule endoscopy

CI:

Confidence interval

HR:

Hazard ratio

IQR:

Interquartile range

LS:

Lewis score

PC:

Patency capsule

T2T:

Treat to target

TNF:

Tumor necrosis factor

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Authors

Contributions

HS had the original idea for this study and was involved in writing the original study protocol, data collection, and writing manuscript. IA was involved in data collection and writing manuscript. JK, YS, RM, MK, YK, YK, and AM contributed to discussions and reviewed manuscript. All authors approved the final version of the article, including the authorship list.

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Correspondence to Hisashi Shiga.

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Shiga, H., Abe, I., Kusaka, J. et al. Capsule Endoscopy Is Useful for Postoperative Tight Control Management in Patients with Crohn’s Disease. Dig Dis Sci (2021). https://doi.org/10.1007/s10620-021-06841-6

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Keywords

  • Capsule endoscopy
  • Crohn’s disease
  • Postoperative recurrence
  • Tight control
  • Treat-to-target strategy