Single-balloon Enteroscopy for Evaluation of Small Bowel Crohn Disease Strictures: Peripheral Blood Lymphocytes As a Risk Factor for Strictures

Background: Few reports have focused on single-balloon enteroscopy (SBE) for evaluation of small bowel Crohn disease (CD) strictures. The aim of this study was to analyze the relationships between peripheral blood inflammatory markers and small bowel CD strictures observed by SBE. Materials and Methods: CD patients who underwent SBE between January 2016 and December 2020 were enrolled. The clinical characteristics and peripheral blood inflammatory markers were collected and analyzed to screen for predictive factors significantly associated with small bowel CD strictures. Results: A total of 221 CD patients underwent SBE. The lymphocyte (LC) counts in peripheral blood were significantly lower in the active group (n=178) than in the inactive group (n=43) according to the simple endoscopic score for CD (SES-CD), P=0.011, and was correlated with the SES-CD (r=−0.134, P=0.047). The LC levels were significantly lower in the stricture group (n=116) than in the nonstricture group (n=105) based on whether small bowel strictures developed, P=0.000, and LC was a risk factor for strictures in the multivariate analysis [hazard ratio (HR), 2.332; 95% CI, 1.102-4.937; P=0.027]. In the subgroup analysis, LC levels notably decreased after stricture aggravation (P=0.000). Forty-seven patients who underwent small bowel resection underwent SBE at 6 to 12 months after surgery. The LC level was significantly lower in the postoperative patients with strictures (P=0.025), and LC (HR, 4.444; 95% CI, 1.265-15.617; P=0.020) was a risk of postoperative strictures by univariate analysis, but the age at diagnosis (HR, 6.462; 95% CI, 1.272-22.560; P=0.022) was an independent risk factor by multivariate analysis. Conclusion: Peripheral blood LC levels were correlated with SES-CD and gradually decreased as the intestinal stricture increased in small bowel CD patients. The LC level was also significantly lower in the postoperative CD patients with strictures. The level of LC was a risk factor for small bowel strictures. These results suggest that peripheral blood LC could be a novel marker of small bowel CD strictures to guide CD diagnosis and therapy.

[1]  Alexander N. Levy,et al.  Endoscopic evaluation of surgically altered bowel in inflammatory bowel disease: a consensus guideline from the Global Interventional Inflammatory Bowel Disease Group. , 2021, The lancet. Gastroenterology & hepatology.

[2]  M. Baker,et al.  Prevention and Treatment of Stricturing Crohn’s Disease – Perspectives and Challenges , 2020, Expert review of gastroenterology & hepatology.

[3]  Rachit Agarwal,et al.  Single-balloon enteroscopy in management of small-bowel disorders , 2020, Indian Journal of Gastroenterology.

[4]  M. Villa,et al.  Enteroscopy in children and adults with inflammatory bowel disease , 2020, World journal of gastroenterology.

[5]  R. Enns,et al.  Capsule Endoscopy and Small Bowel Enteroscopy: Have They Rendered the Radiologist Obsolete? , 2019, Gastrointestinal endoscopy clinics of North America.

[6]  B. Shen.  Endoscopic management of inflammatory bowel disease-associated complications. , 2019, Current opinion in gastroenterology.

[7]  Ming-jun Sun,et al.  IL-17A Promotes Initiation and Development of Intestinal Fibrosis Through EMT , 2018, Digestive Diseases and Sciences.

[8]  A. Gasbarrini,et al.  The use of single balloon enteroscopy in Crohn’s disease and its impact on clinical outcome , 2018, Scandinavian journal of gastroenterology.

[9]  L. Peyrin-Biroulet,et al.  Crohn's disease , 2017, The Lancet.

[10]  D. Binion,et al.  Endoscopic Evaluation and Management of the Postoperative Crohn's Disease Patient. , 2016, Gastrointestinal endoscopy clinics of North America.

[11]  C. Luceri,et al.  Long-term Results and Recurrence-Related Risk Factors for Crohn Disease in Patients Undergoing Side-to-Side Isoperistaltic Strictureplasty. , 2016, JAMA surgery.

[12]  M. Regueiro,et al.  A Practical Approach to Preventing Postoperative Recurrence in Crohn’s Disease , 2016, Current Gastroenterology Reports.

[13]  S. Ingle,et al.  Crohn's disease with gastroduodenal involvement: Diagnostic approach. , 2015, World journal of clinical cases.

[14]  A. Amiot,et al.  European evidence based consensus for endoscopy in inflammatory bowel disease. , 2013, Journal of Crohn's & colitis.

[15]  F. Remzi,et al.  Crohn's disease complicated by strictures: a systematic review , 2013, Gut.

[16]  P. von der Weid,et al.  Role of the lymphatic system in the pathogenesis of Crohn's disease , 2011, Current opinion in gastroenterology.

[17]  T. Wynn,et al.  Fibrosis is regulated by Th2 and Th17 responses and by dynamic interactions between fibroblasts and macrophages. , 2011, American journal of physiology. Gastrointestinal and liver physiology.

[18]  C. Bernstein,et al.  Targeting IL-12/IL-23 by Employing a p40 Peptide-Based Vaccine Ameliorates TNBS-Induced Acute and Chronic Murine Colitis , 2011, Molecular medicine.

[19]  J. Leighton,et al.  Enteroscopy in the diagnosis and management of Crohn disease. , 2009, Gastrointestinal endoscopy clinics of North America.

[20]  D. Adams,et al.  Lymphocyte homing and its role in the pathogenesis of IBD. , 2008, Inflammatory bowel diseases.

[21]  T. Inoue,et al.  In vivo demonstration of T lymphocyte migration and amelioration of ileitis in intestinal mucosa of SAMP1/Yit mice by the inhibition of MAdCAM‐1 , 2005, Clinical and experimental immunology.

[22]  N. Hosoe,et al.  Increased lymphocyte trafficking to colonic microvessels is dependent on MAdCAM‐1 and C‐C chemokine mLARC/CCL20 in DSS‐induced mice colitis , 2005, Clinical and experimental immunology.

[23]  P. Rutgeerts,et al.  Medical Therapy for Crohn's Disease Strictures , 2004, Inflammatory bowel diseases.

[24]  M. Scarpa,et al.  Risk factors for recurrence of stenosis in Crohn's disease. , 2003, Acta bio-medica : Atenei Parmensis.