Clinical impact of ultrathin colonoscopy for Crohn's disease patients with strictures.
BACKGROUND AND AIM
Mucosal healing is now the ideal treatment goal for patients with Crohn's disease (CD) and endoscopy is suitable for both visualizing the intestinal mucosa and optimizing treatment according to the objective endoscopic findings; however, passing through strictures with a conventional colonoscope is sometimes difficult. An ultrathin colonoscope (outer diameter 9.2 mm) has been developed for superior insertion performance.


METHODS
CD patients with strictures that could not be passed with a conventional colonoscope were eligible for entry into the study. We investigated the rate of passage of the ultrathin colonoscope beyond strictures. We also investigated the clinical impact of optimizing the treatment strategy according to the endoscopic findings beyond the stricture.


RESULTS
Of 49 patients, the ultrathin colonoscope could pass the stricture in 59.2% (29/49). The main reason for failure compared with the "pass" group was anal stricture (P = 0.005). When including finger bougie for severe anal stricture, passage of the stricture was achieved in 83.7% (41/49) of cases and the oral mucosa beyond the stricture was visualized. In these cases, 56.1% (23/41) had treatment efficacy confirmed and 43.9% (18/41) required a change of treatment. Importantly, half (9/18) of them were in clinical remission. There were no complications of the study.


CONCLUSION
The ultrathin colonoscope could provide optimized treatment based on objective findings of the activity of the oral-side mucosa in CD patients complicated with stricture. Selection of the appropriate endoscope to visualize the responsible lesion is essential to optimize the treatment strategy in each case of CD.
['Morimoto|Kenichi|K|', 'Watanabe|Kenji|K|', 'Noguchi|Atsushi|A|', 'Miyazaki|Takako|T|', 'Nagami|Yasuaki|Y|', 'Sugimori|Satoshi|S|', 'Kamata|Noriko|N|', 'Sogawa|Mitsue|M|', 'Tanigawa|Tetsuya|T|', 'Yamagami|Hirokazu|H|', 'Shiba|Masatsugu|M|', 'Tominaga|Kazunari|K|', 'Watanabe|Toshio|T|', 'Fujiwara|Yasuhiro|Y|', 'Arakawa|Tetsuo|T|']
D000328:Adult D003106:Colon D003113:Colonoscopy D003251:Constriction, Pathologic D003424:Crohn Disease D005260:Female D006801:Humans D007413:Intestinal Mucosa D008297:Male D008875:Middle Aged D016896:Treatment Outcome
Crohn's disease mucosal healing ultrathin colonoscope inflammatory bowel disease intestinal stricture