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

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.