In Crohn’s disease, postoperative endoscopic activity of small bowel lesions outside the scope of ileocolonoscopy has been insufficiently studied.
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.
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.
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).
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.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Treat to target
Tumor necrosis factor
Pariente B, Cosnes J, Danese S et al. Development of the Crohnʼs disease digestive damage score, the Lémann score. Inflamm Bowel Dis 2011;17:1415–1422. https://doi.org/10.1002/ibd.21506.
Frolkis AD, Lipton DS, Fiest KM et al. Cumulative incidence of second intestinal resection in Crohn’s disease: a systematic review and meta-Analysis of population-based studies. Am J Gastroenterol 2014;109:1739–1748. https://doi.org/10.1038/ajg.2014.297.
Oriuchi T, Hiwatashi N, Kinouchi Y et al. Clinical course and longterm prognosis of Japanese patients with Crohn?s disease: predictive factors, rates of operation, and mortality. J Gastroenterol 2003;38:942–953. https://doi.org/10.1007/s00535-003-1177-9.
Kusaka J, Shiga H, Kuroha M et al. Risk factors associated with postoperative recurrence and repeat surgery in Japanese patients with Crohn’s disease. Int J Colorectal Dis 2017;32:1407–1413. https://doi.org/10.1007/s00384-017-2867-8.
Peyrin-Biroulet L, Sandborn W, Sands BE et al. Selecting therapeutic targets in inflammatory bowel disease (STRIDE): determining therapeutic goals for treat-to-target. Am J Gastroenterol 2015;110:1324–1338. https://doi.org/10.1038/ajg.2015.233.
Gionchetti P, Dignass A, Danese S et al. 3rd European evidence-based consensus on the diagnosis and management of Crohn’s disease 2016: part 2: surgical management and special situations. J Crohn’s Colitis 2017;11:135–149. https://doi.org/10.1093/ecco-jcc/jjw169.
Regueiro M, Velayos F, Greer JB et al. American gastroenterological association institute technical review on the management of Crohn’s disease after surgical resection. Gastroenterology 2017;152:277-295.e3. https://doi.org/10.1053/j.gastro.2016.10.039.
De Cruz P, Kamm MA, Hamilton AL et al. Crohn’s disease management after intestinal resection: a randomised trial. Lancet 2015;385:1406–1417. https://doi.org/10.1016/S0140-6736(14)61908-5.
Kusaka J, Shiga H, Kuroha M et al. Residual lesions on capsule endoscopy is associated with postoperative clinical recurrence in patients with Crohn’s disease. Dig Dis Sci 2018;63:768–774. https://doi.org/10.1007/s10620-018-4942-6.
Dionisio PM, Gurudu SR, Leighton JA et al. Capsule endoscopy has a significantly higher diagnostic yield in patients with suspected and established small-Bowel Crohnʼs disease: a meta-analysis. Am J Gastroenterol 2010;105:1240–1248. https://doi.org/10.1038/ajg.2009.713.
Pennazio M, Spada C, Eliakim R et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European society of gastrointestinal endoscopy (ESGE) clinical guideline. Endoscopy 2015;47:352–386. https://doi.org/10.1055/s-0034-1391855.
Greener T, Klang E, Yablecovitch D et al. The impact of magnetic resonance enterography and capsule endoscopy on the re-classification of disease in patients with known Crohn’s disease: a prospective Israeli IBD research nucleus (IIRN) study. J Crohns Colitis 2016;10:525–531. https://doi.org/10.1093/ecco-jcc/jjw006.
Kopylov U, Yung DE, Engel T et al. Diagnostic yield of capsule endoscopy versus magnetic resonance enterography and small bowel contrast ultrasound in the evaluation of small bowel Crohn’s disease: systematic review and meta-analysis. Dig Liver Dis 2017;49:854–863. https://doi.org/10.1016/j.dld.2017.04.013.
González-Suárez B, Rodriguez S, Ricart E et al. Comparison of capsule endoscopy and magnetic resonance enterography for the assessment of small Bowel Lesions in Crohn’s disease. Inflamm Bowel Dis 2018;24:775–780. https://doi.org/10.1093/ibd/izx107.
Enns RA, Hookey L, Armstrong D et al. Clinical practice guidelines for the use of video capsule endoscopy. Gastroenterology 2017;152:497–514. https://doi.org/10.1053/j.gastro.2016.12.032.
Yao T, Matsui T, Hiwatashi N. Crohnʼs disease in Japan. Dis Colon Rectum 2000;43:S85-93. https://doi.org/10.1007/BF02237231.
Gralnek IM, Defranchis R, Seidman E et al. Development of a capsule endoscopy scoring index for small bowel mucosal inflammatory change. Aliment Pharmacol Ther 2008;27:146–154. https://doi.org/10.1111/j.1365-2036.2007.03556.x.
Cotter J, de Castro FD, Magalhaes J et al. Validation of the Lewis score for the evaluation of small-bowel Crohn’s disease activity. Endoscopy 2015;47:330–335. https://doi.org/10.1055/s-0034-1390894.
Lescut D, Vanco D, Bonniere P et al. Perioperative endoscopy of the whole small bowel in Crohn’s disease. Gut 1993;34:647–649. https://doi.org/10.1136/gut.34.5.647.
Klein O, Colombel JF, Lescut D et al. Remaining small bowel endoscopic lesions at surgery have no influence on early anastomotic recurrences in Crohn’s disease. Am J Gastroenterol 1995;90:1949–1952
Kono T. Prospective postsurgical capsule endoscopy in patients with Crohn’s disease. World J Gastrointest Endosc 2014;6:88. https://doi.org/10.4253/wjge.v6.i3.88.
Bourreille A. Wireless capsule endoscopy versus ileocolonoscopy for the diagnosis of postoperative recurrence of Crohn’s disease: a prospective study. Gut 2006;55:978–983. https://doi.org/10.1136/gut.2005.081851.
Pons Beltrán V, Nos P, Bastida G et al. Evaluation of postsurgical recurrence in Crohn’s disease: a new indication for capsule endoscopy? Gastrointest Endosc 2007;66:533–540. https://doi.org/10.1016/j.gie.2006.12.059.
Han Z-M, Qiao W-G, Ai X-Y et al. Impact of capsule endoscopy on prevention of postoperative recurrence of Crohn’s disease. Gastrointest Endosc 2018;87:1489–1498. https://doi.org/10.1016/j.gie.2018.01.017.
Kopylov U, Yablecovitch D, Lahat A et al. Detection of small bowel mucosal healing and deep remission in patients with known small bowel Crohn’s disease using biomarkers, capsule endoscopy, and imaging. Am J Gastroenterol 2015;110:1316–1323. https://doi.org/10.1038/ajg.2015.221.
Singh S, Garg SK, Pardi DS et al. Comparative efficacy of pharmacologic interventions in preventing relapse of Crohn’s disease after surgery: a systematic review and network meta-analysis. Gastroenterology 2015;148:e2. https://doi.org/10.1053/j.gastro.2014.09.031.
De Cruz P, Kamm MA, Hamilton AL et al. Efficacy of thiopurines and adalimumab in preventing Crohn’s disease recurrence in high-risk patients - a POCER study analysis. Aliment Pharmacol Ther 2015;42:867–879. https://doi.org/10.1111/apt.13353.
Gal E, Geller A, Fraser G et al. Assessment and validation of the new capsule endoscopy Crohn’s disease activity index (CECDAI). Dig Dis Sci 2008;53:1933–1937. https://doi.org/10.1007/s10620-007-0084-y.
Niv Y, Ilani S, Levi Z et al. Validation of the capsule endoscopy Crohn’s disease activity index (CECDAI or Niv score): a multicenter prospective study. Endoscopy 2012;44:21–26. https://doi.org/10.1055/s-0031-1291385.
Koulaouzidis A, Douglas S, Plevris JN. Lewis score correlates more closely with Fecal Calprotectin than capsule endoscopy Crohn’s disease activity index. Dig Dis Sci 2012;57:987–993. https://doi.org/10.1007/s10620-011-1956-8.
Yablecovitch D, Lahat A, Neuman S et al. The Lewis score or the capsule endoscopy Crohn’s disease activity index: which one is better for the assessment of small bowel inflammation in established Crohn’s disease? Therap Adv Gastroenterol 2018;11:1756283X1774778. https://doi.org/10.1177/1756283X17747780.
Omori T, Kambayashi H, Murasugi S et al. Comparison of Lewis score and capsule endoscopy Crohn’s disease activity index in patients with Crohn’s disease. Dig Dis Sci 2020;65:1180–1188. https://doi.org/10.1007/s10620-019-05837-7.
Wright EK, Kamm MA, De Cruz P et al. Measurement of fecal calprotectin improves monitoring and detection of recurrence of Crohn’s disease after surgery. Gastroenterology 2015;148:938-947.e1. https://doi.org/10.1053/j.gastro.2015.01.026.
Brand EC, Elias SG, Minderhoud IM et al. Systematic review and external validation of prediction models based on symptoms and biomarkers for identifying endoscopic activity in Crohn’s disease. Clin Gastroenterol Hepatol 2020;18:1704–1718. https://doi.org/10.1016/j.cgh.2019.12.014.
Conflict of interest
The authors declare that they have no conflict of interest.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
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
- Capsule endoscopy
- Crohn’s disease
- Postoperative recurrence
- Tight control
- Treat-to-target strategy