Supplementary Material for: Long-term monitoring and clinical implications of small bowel capsule endoscopy in patients with Crohn's disease with small bowel lesions: A Retrospective Analysis

Introduction: Crohn's disease (CD) induces persistent inflammation throughout the gastrointestinal (GI) tract, potentially resulting in complications such as intestinal stenosis and fistulas, particularly in the small bowel. Small-bowel capsule endoscopy (SBCE) is recommended for monitoring CD, especially when GI tract patency is maintained. This study aimed to retrospectively assess patients with CD who underwent SBCE to determine the timing of clinical changes and address the current lack of evidence regarding GI tract patency loss during CD treatment.
Methods: Of the 166 consecutive patients who underwent SBCE at our institution, 120 were followed up and included in this study. Forty-six patients were excluded due to colitis type or immediate treatment changes post-SBCE. This study focused on the primary and secondary endpoints, including the cumulative stricture-free rate of the GI tract, emergency hospitalization post-SBCE, and post-SBCE treatment strategies, at the discretion of the attending physicians.
Results: Demographic data revealed that the mean age of the study population was 43 years and that there was a male predominance (75%). The median disease duration was 12 years and the mean Crohn’s Disease Activity Index was 98. During a 1,486-day observation period, 37% of patients experienced treatment changes. A Lewis score of >264 and perianal lesions were identified as independent risk factors for additional treatment needs. Emergency hospitalization occurred in 6% of patients and GI patency failure in 11%. Female sex and Lewis score>264 were associated with higher risks. GI patency rate declined two years after SBCE.
Conclusions: For patients who experienced no treatment changes based on SBCE results, it is recommended to undergo SBCE monitoring at intervals of no longer than two years.

引言：克罗恩病（Crohn’s Disease, CD）会引发胃肠道（gastrointestinal, GI）全程持续性炎症，可能导致肠道狭窄与瘘管等并发症，尤以小肠受累为著。小肠胶囊内镜（small-bowel capsule endoscopy, SBCE）被推荐用于CD的病情监测，尤其适用于胃肠道通畅的患者。本研究旨在对接受小肠胶囊内镜检查的CD患者进行回顾性评估，以明确临床病情变化的时间节点，并解决当前CD治疗期间胃肠道通畅性丧失相关证据匮乏的问题。
方法：本机构共166例连续性患者接受了小肠胶囊内镜检查，其中120例完成随访并纳入本研究；另有46例患者因罹患结肠炎表型或于小肠胶囊内镜检查后即刻调整治疗方案而被排除。本研究的主要及次要终点由主管医师判定，包括胃肠道无狭窄累积发生率、检查后急诊住院率以及检查后治疗策略调整情况。
结果：人口统计学资料显示，本研究队列的平均年龄为43岁，男性占比占优（75%）；中位病程为12年，平均克罗恩病活动指数（Crohn’s Disease Activity Index, CDAI）得分为98分。在1486天的观察期内，37%的患者出现了治疗方案调整；Lewis评分（Lewis score）＞264分以及肛周病变被确定为需追加治疗的独立危险因素。6%的患者发生急诊住院，11%的患者出现胃肠道通畅性丧失；女性性别以及Lewis评分＞264分与更高的不良事件风险相关。小肠胶囊内镜检查后2年，胃肠道通畅率出现下降。
结论：对于根据小肠胶囊内镜检查结果未出现治疗方案调整的患者，推荐间隔不超过2年再次行小肠胶囊内镜监测。