Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 14, 2015; 21(34): 9974-9981
Published online Sep 14, 2015. doi: 10.3748/wjg.v21.i34.9974
Clinical utility of a new endoscopic scoring system for Crohn’s disease
Kazuhiro Morise, Takafumi Ando, Osamu Watanabe, Masanao Nakamura, Ryoji Miyahara, Osamu Maeda, Kazuhiro Ishiguro, Yoshiki Hirooka, Hidemi Goto
Kazuhiro Morise, Takafumi Ando, Osamu Watanabe, Masanao Nakamura, Ryoji Miyahara, Osamu Maeda, Kazuhiro Ishiguro, Hidemi Goto, Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi 466-8550, Japan
Yoshiki Hirooka, Hidemi Goto, Department of Endoscopy, Nagoya University Hospital, Nagoya, Aichi 466-8550, Japan
Author contributions: Morise K, Ando T, and Watanabe O designed the research; Nakamura M, Miyahara R, Maeda O, Ishiguro K, and Hirooka Y collected the data; Morise K and Ando T wrote the paper; Goto H provided a critical review of the manuscript.
Institutional review board statement: The study was approved by the Ethical Review Committee of Nagoya University Hospital.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Takafumi Ando, MD, PhD, Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan. takafumiando-gi@umin.ac.jp
Telephone: +81-52-744-2144 Fax: +81-52-744-2175
Received: March 6, 2015
Peer-review started: March 10, 2015
First decision: April 13, 2015
Revised: May 12, 2015
Accepted: July 15, 2015
Article in press: July 15, 2015
Published online: September 14, 2015
Processing time: 191 Days and 23.7 Hours
Abstract

AIM: To evaluate the clinical value of the newly modified Simple Endoscopic Score for Crohn’s disease (mSES-CD).

METHODS: Seventy-six Crohn’s disease (CD) patients who underwent transanal double balloon endoscopy (DBE) in our hospital between 2003 and 2012 were retrospectively reviewed. DBE is defined as small intestinal endoscopy using two attached balloons. We included patients with stenosis which hampered passage of the scope and those who underwent DBE with observation for at least 80 cm from the ileocecal valve. Our new mSES-CD assesses the endoscopic activity of two consecutive small intestinal segments located 0-40 cm and 40-80 cm from the ileocecal valve by DBE, in addition to the activity of four colorectal segments. To compare the usefulness of mSES-CD with SES-CD, we similarly divided the patients into two groups according to total mSES-CD score (low disease activity group, < 4; high disease activity group, ≥ 4). The clinical value of mSES-CD in predicting clinical outcome in patients with CD was evaluated using the occurrence of surgery after DBE as an endpoint.

RESULTS: Median age of the 76 CD patients was 36 years (range, 16-71). Thirty-nine patients had stenosis which hampered passage of the DBE to 80 cm on the proximal side from the ileocecal valve. Median evaluable length of small intestine by DBE was 80 cm (range, 3-200). A total of 74 patients had one or more small intestinal lesions detected by DBE, of which 62 (83.8%) were within 80 cm of the ileocecal valve on the proximal side. Only two patients (2.7%) with proximal-side lesions more than 80 cm from the ileocecal valve did not have lesions within 80 cm. Patients with high mSES-CD scores showed significantly shorter surgery-free survival than those with low scores (P < 0.05). In contrast, surgery-free survival did not significantly differ between the low and high SES-CD groups (P > 0.05). Multivariate analysis by a Cox proportional hazards model identified mSES-CD as an independent factor for surgery-free survival.

CONCLUSION: mSES-CD is useful in evaluating the risk of surgery-free survival in patients with CD.

Keywords: Crohn’s disease; Modified Simple Endoscopic Score; Mucosal healing; Double balloon endoscopy; Surgery-free survival

Core tip: Modified Simple Endoscopic Score for Crohn’s disease (mSES-CD) is a new scoring method which includes assessment of the endoscopic activity of small intestinal as well as colorectal lesions by double balloon endoscopy. mSES-CD is useful in evaluating the risk of salvage surgery-free survival in patients with Crohn’s disease.