Skip to main content
SpringerLink
Log in

Residual Lesions on Capsule Endoscopy Is Associated with Postoperative Clinical Recurrence in Patients with Crohn’s Disease

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

In order to optimize postoperative therapy in patients with Crohn’s disease (CD), it is important to detect endoscopic recurrence preceding clinical recurrence. However, we have little knowledge about how high the rate of residual lesions is and whether these lesions have an influence on postoperative course or not.

Aims

To assess residual lesions in small bowel immediately after surgery.

Methods

Capsule endoscopy (CE) was performed immediately after surgery (< 3 months), and endoscopic activity was assessed using the Lewis score (LS) composed of the highest tertile score (in first, second, and third tertile) and the stenosis score (in whole small intestine). The relationship between these residual lesions and postoperative clinical recurrence was prospectively evaluated.

Results

After assessing patency using a patency capsule, CE was performed in 25 patients. The mean LS was 751.3, and 84.0% (21/25) had endoscopic activity. These lesions were detected by preoperative examinations in 0% and by a serosal side view during surgery in 16.0%. Regarding the cumulative clinical recurrence rate according to endoscopic severity (normal, mild, and moderate-to-severe) immediately after surgery, no significant difference was found. However, comparing groups divided according to the highest tertile score, the cumulative clinical recurrence rate was significantly higher in the group with the highest third tertile score. Furthermore, patients with ulcers in the third tertile had a significantly higher recurrence rate.

Conclusions

Many cases with CD had endoscopic activity immediately after “curative” surgery. These residual lesions, especially in the distal small intestine, were associated with postoperative clinical recurrence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Frolkis AD, Dykeman J, Negron ME, et al. Risk of surgery for inflammatory bowel diseases has decreased over time: a systematic review and meta-analysis of population-based studies. Gastroenterology. 2013;145:996–1006.

    Article  PubMed  Google Scholar 

  2. 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.

    Article  PubMed  Google Scholar 

  3. 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.

    Article  PubMed  Google Scholar 

  4. 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 Crohns Colitis. 2017;11:135–149.

    Article  PubMed  Google Scholar 

  5. 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.

    Article  PubMed  Google Scholar 

  6. Olaison G, Smedh K, Sjodahl R. Natural course of crohn’s disease after ileocolic resection: endoscopically visualised ileal ulcers preceding symptoms. Gut. 1992;33:331–335.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. De Cruz P, Kamm MA, Hamilton AL, et al. Crohn’s disease management after intestinal resection: A randomised trial. Lancet. 2015;385:1406–1417.

    Article  PubMed  Google Scholar 

  8. Bourreille A, Jarry M, D’Halluin PN, et al. Wireless capsule endoscopy versus ileocolonoscopy for the diagnosis of postoperative recurrence of Crohn’s disease: a prospective study. Gut. 2006;55:978–983.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. 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.

    Article  PubMed  Google Scholar 

  10. Costamagna G, Shah SK, Riccioni ME, et al. A prospective trial comparing small bowel radiographs and video capsule endoscopy for suspected small bowel disease. Gastroenterology. 2002;123:999–1005.

    Article  PubMed  Google Scholar 

  11. Hara AK, Leighton JA, Sharma VK, Fleischer DE. Small bowel: preliminary comparison of capsule endoscopy with barium study and CT. Radiology. 2004;230:260–265.

    Article  PubMed  Google Scholar 

  12. Schreyer AG, Golder S, Seitz J, Herfarth H. New diagnostic avenues in inflammatory bowel diseases. Capsule endoscopy, magnetic resonance imaging and virtual enteroscopy. Dig Dis. 2003;21:129–137.

    Article  PubMed  Google Scholar 

  13. Voderholzer WA, Ortner M, Rogalla P, Beinhölzl J, Lochs H. Diagnostic yield of wireless capsule enteroscopy in comparison with computed tomography enteroclysis. Endoscopy. 2003;35:1009–1014.

    Article  CAS  PubMed  Google Scholar 

  14. Matsui T. Proposed diagnostic criteria for Crohn’s disease. In: Annals Reports of Research Group of Intractable Inflammatory Bowel Disease Subsidized by the Ministry of Health, Labour and Welfare of Japan 2013:41–45 (In Japanese).

  15. Gralnek IM, Defranchis R, Seidman E, Leighton JA, Legnani P, Lewis BS. Development of a capsule endoscopy scoring index for small bowel mucosal inflammatory change. Aliment Pharmacol Ther. 2008;27:146–154.

    Article  CAS  PubMed  Google Scholar 

  16. Lescut D, Vanco D, Bonniere P, et al. Perioperative endoscopy of the whole small bowel in Crohn’s disease. Gut. 1993;34:647–649.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. 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.

    CAS  PubMed  Google Scholar 

  18. Kono T, Hida N, Nogami K, et al. Prospective postsurgical capsule endoscopy in patients with Crohn’s disease. World J Gastrointest Endosc. 2014;6:88–98.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Triester SL, Leighton JA, Leontiadis GI, et al. A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with non-stricturing small bowel Crohn’s disease. Am J Gastroenterol. 2006;101:954–964.

    Article  PubMed  Google Scholar 

  20. Colombel JF, Panaccione R, Bossuyt P, et al. Effect of tight control management on Crohn’s disease (CALM): a multicentre, randomised, controlled phase 3 trial. Lancet. 2018;390:2779–2789.

    Article  PubMed  Google Scholar 

  21. Washio E, Esaki M, Maehata Y, et al. Proton pump inhibitors increase incidence of nonsteroidal anti-inflammatory drug-induced small bowel injury: A randomized, placebo-controlled trial. Clin Gastroenterol Hepatol. 2016;14:809–815.

    Article  CAS  PubMed  Google Scholar 

  22. Wallace JL, Syer S, Denou E, et al. Proton pump inhibitors exacerbate NSAID-induced small intestinal injury by inducing dysbiosis. Gastroenterology. 2011;141:1314–1322.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. Jun Kusaka and Hisashi Shiga contributed equally to this work.

Authors and Affiliations

  1. Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan

    Jun Kusaka, Masatake Kuroha, Tomoya Kimura, Yoichi Kakuta & Tooru Shimosegawa

  2. Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan

    Hisashi Shiga

  3. Division of Gastroenterology and Hepatology, Tohoku Medical and Pharmaceutical University, Sendai, Japan

    Katsuya Endo

  4. Health Administration Center, Center for the Advancement of Higher Education, Tohoku University, Sendai, Japan

    Yoshitaka Kinouchi

Authors
  1. Jun Kusaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hisashi Shiga
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Masatake Kuroha
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tomoya Kimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yoichi Kakuta
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Katsuya Endo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yoshitaka Kinouchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Tooru Shimosegawa
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Hisashi Shiga had the original idea for this study and was involved in writing the original study protocol, data collection, and writing manuscript. Jun Kusaka was involved in data collection and writing manuscript. Masatake Kuroha, Tomoya Kimura, Yoichi Kakuta, Katsuya Endo, Yoshitaka Kinouchi, and Tooru Shimosegawa contributed to discussions and reviewed manuscript.

Corresponding author

Correspondence to Hisashi Shiga.

Ethics declarations

Conflict of interest

All authors have no conflict of interest with respect to the present study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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 63, 768–774 (2018). https://doi.org/10.1007/s10620-018-4942-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-018-4942-6

Keywords

Search

Navigation