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Utility of endoscopic diagnosis for postoperative small-bowel lesions in patients with Crohn's disease at double-balloon endoscopy.

Yamada K, Hirooka Y, Watanabe O, Nakamura M, Yamamura T, Funasaka K, Ohno E, Miyahara R, Kawashima H, Goto H - Nagoya J Med Sci (2015)

Bottom Line: Outcome of the anastomosed lesions was analyzed in the groups treated with and without postoperative anti-TNFα antibody including infliximab and adalimumab.In conclusion, DBE was useful for accurate diagnosis of small-bowel lesions after surgery.Anti-TNFα antibody may help to decrease the postoperative recurrence rate of Crohn's disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.

ABSTRACT
Double-balloon endoscopy (DBE) has enabled precise diagnosis and endoscopic intervention deep within the small bowel. In this study, we determine the factor related to the risk of endoscopic and clinical recurrences in the diagnosis of postoperative lesions including anastomosis for the patients with Crohn's disease. Forty-eight patients (40 men and 8 women) had undergone small bowel resection previously and anastomotic sites were evaluated by Rutgeerts' endoscopic scoring. The factors related to endoscopic and clinical recurrences at anastomosed sites were investigated. The analyzed items included the disease type, anastomosis procedure, frequency of surgery, time to endoscopy after surgery, the presence or absence of treatment with 5-aminosalicylic acid (5-ASA), immunomodulators, steroids, maintenance administration of infliximab, and an elemental diet that required the ingestion of 900 kcal or more per day. Outcome of the anastomosed lesions was analyzed in the groups treated with and without postoperative anti-TNFα antibody including infliximab and adalimumab. DBE was performed 133 times, and 168 anastomosed lesions were observed for enrolled patients. Univariate analysis showed that time to DBE after surgery of 1.5-year or longer and the absence of 5-ASA administration were found to be significant factors leading to both endoscopic and clinical recurrences. The results of Kaplan-Meier estimate and the log rank test demonstrated that the clinical recurrence was avoided more often in the anti-TNFα antibody-treated group compared with the non-treated group. In conclusion, DBE was useful for accurate diagnosis of small-bowel lesions after surgery. Anti-TNFα antibody may help to decrease the postoperative recurrence rate of Crohn's disease.

No MeSH data available.


Related in: MedlinePlus

Long-term outcome with or without anti-TNFα antibody (Follow-up Median: 51 months, Range: 5-194 months)
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fig2: Long-term outcome with or without anti-TNFα antibody (Follow-up Median: 51 months, Range: 5-194 months)

Mentions: The 48 postoperative patients were divided into two groups, with and without administration of anti-TNFα antibody, which were comprised of 22 and 26 patients, respectively. The grade 4 outcomes based on the classification of Rutgeerts et al. were analyzed based upon these 2 treatment groups. The anti-TNFα antibodies were infliximab in 21 patients and adalimumab in 6 patients (5 patients overlapped). They included administration with irregular periods and on demand. The outcomes during the follow-up period (median duration: 51 months) were analyzed using the Kaplan-Meier estimate and the log rank test. The conditions leading to clinical recurrence were avoided more often in the anti-TNFα antibody-treated group compared with the non-treated group (Figure 2).


Utility of endoscopic diagnosis for postoperative small-bowel lesions in patients with Crohn's disease at double-balloon endoscopy.

Yamada K, Hirooka Y, Watanabe O, Nakamura M, Yamamura T, Funasaka K, Ohno E, Miyahara R, Kawashima H, Goto H - Nagoya J Med Sci (2015)

Long-term outcome with or without anti-TNFα antibody (Follow-up Median: 51 months, Range: 5-194 months)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4574328&req=5

fig2: Long-term outcome with or without anti-TNFα antibody (Follow-up Median: 51 months, Range: 5-194 months)
Mentions: The 48 postoperative patients were divided into two groups, with and without administration of anti-TNFα antibody, which were comprised of 22 and 26 patients, respectively. The grade 4 outcomes based on the classification of Rutgeerts et al. were analyzed based upon these 2 treatment groups. The anti-TNFα antibodies were infliximab in 21 patients and adalimumab in 6 patients (5 patients overlapped). They included administration with irregular periods and on demand. The outcomes during the follow-up period (median duration: 51 months) were analyzed using the Kaplan-Meier estimate and the log rank test. The conditions leading to clinical recurrence were avoided more often in the anti-TNFα antibody-treated group compared with the non-treated group (Figure 2).

Bottom Line: Outcome of the anastomosed lesions was analyzed in the groups treated with and without postoperative anti-TNFα antibody including infliximab and adalimumab.In conclusion, DBE was useful for accurate diagnosis of small-bowel lesions after surgery.Anti-TNFα antibody may help to decrease the postoperative recurrence rate of Crohn's disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.

ABSTRACT
Double-balloon endoscopy (DBE) has enabled precise diagnosis and endoscopic intervention deep within the small bowel. In this study, we determine the factor related to the risk of endoscopic and clinical recurrences in the diagnosis of postoperative lesions including anastomosis for the patients with Crohn's disease. Forty-eight patients (40 men and 8 women) had undergone small bowel resection previously and anastomotic sites were evaluated by Rutgeerts' endoscopic scoring. The factors related to endoscopic and clinical recurrences at anastomosed sites were investigated. The analyzed items included the disease type, anastomosis procedure, frequency of surgery, time to endoscopy after surgery, the presence or absence of treatment with 5-aminosalicylic acid (5-ASA), immunomodulators, steroids, maintenance administration of infliximab, and an elemental diet that required the ingestion of 900 kcal or more per day. Outcome of the anastomosed lesions was analyzed in the groups treated with and without postoperative anti-TNFα antibody including infliximab and adalimumab. DBE was performed 133 times, and 168 anastomosed lesions were observed for enrolled patients. Univariate analysis showed that time to DBE after surgery of 1.5-year or longer and the absence of 5-ASA administration were found to be significant factors leading to both endoscopic and clinical recurrences. The results of Kaplan-Meier estimate and the log rank test demonstrated that the clinical recurrence was avoided more often in the anti-TNFα antibody-treated group compared with the non-treated group. In conclusion, DBE was useful for accurate diagnosis of small-bowel lesions after surgery. Anti-TNFα antibody may help to decrease the postoperative recurrence rate of Crohn's disease.

No MeSH data available.


Related in: MedlinePlus