Clinical features of 44 patients with small bowel Crohn / 中南大学学报(医学版)

OBJECTIVES@#At present, there are many studies on Crohn's disease of terminal ileum and colon, but few studies on Crohn's disease of small intestine alone. This study aims to analyze the clinical features and therapeutic effect of small bowel in adult patients with Crohn's disease so as to strengthen the diagnosis and treatment for this disease.@*METHODS@#From July 1, 2015 to October 31, 2018, patients with small bowel Crohn's disease at Department of Gastroenterology, Third Xiangya Hospital of Central South University, were enrolled. At the same time, patients' demographics and clinical data were collected.@*RESULTS@#A total of 44 patients were small bowel Crohn's disease. Among them, 40 patients were male. The age at diagnosis was (35.8±10.3) years old and disease duration was (35.2±59.5) months. The subtypes included 29(65.9%) of ileum, 7(15.9%) of jejunum, 8(18.2%) of ileum with jejunum. There were 27(61.4%) of stricture behavior, 4(9.1%) of penetrating behavior, and 13(29.5%) of non-stricture and non-penetrating behavior. Endoscopic visible stricture (29/85, 34.1%) was common, followed by longitudinal ulcers (27/85, 31.8%). Non-caseate granulomatous were found in 2 cases (4.5%). The score of Crohn's disease activity index was correlated to hemoglobin, hematocrit, and erythrocyte sedimentation rate (all @*CONCLUSIONS@#Patients with ileum account for a large proportion in patients with small bowel Crohn's disease. Stricture is more common in small bowel Crohn's disease. Stricture and longitudinal ulcer are more common under enteroscopy. Crohn's disease activity index is correlated to hemoglobin, red blood cell specific volume, and erythrocyte sedimentation rate. The most common complication is intestinal obstruction. Mesalazine is less effective on small bowel Crohn's disease.

Treatment of inflammatory bowel disease-relevant strictures by double balloon enteroscopy / 中南大学学报(医学版)

To evaluate the safety and efficacy of endoscopic balloon dilation (EBD) and endoscopic stricturotomy with needle knife (NKSt) in patients with inflammatory bowel diseases (IBD)-relevant strictures. 
 Methods: From July 2015 to September 2018, 14 patients undergoing double balloon-enteroscopy at the Third Xiangya Hospital of Central South University were enrolled. There was a total of 16 lesions. Endoscopic intervention was performed for 16 times. EBD was done for 11 times, and 5 stricturotomies were carried out. Regular follow-up and examinations were done to observe whether there was remission or recurrence of clinical symptoms and replacement surgery.
 Results: All 14 patients were successfully treated by endoscopy, and the success rate was 100%. Postoperative clinical symptoms were alleviated, and serious complications, such as perforation or hemorrhaging, did not occur. Obstructive symptoms were effectively alleviated at a median follow-up of 26.1 months (5.9-35.3 months) and 8.3 months (1.6-17.8 months) for patients with balloon dilatation and stricturotomy, respectively. Two patients presented with symptoms of obstruction. These were given conservative symptomatic treatment without surgical intervention.
 Conclusion: Enteroscopic treatments (EBD and NKSt) are safe and effective for intestinal strictures, and can prolong the time before surgical intervention is needed.