Development of a Novel Endoscopic Scoring System to Predict Relapse after Surgery in Intestinal Behçet’s Disease
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background/Aims: The cumulative surgery rate and postoperative relapse of intestinal Behçet’s disease (BD) have been reported to be high. This study aimed to establish a scoring system based on follow-up endoscopic findings that can predict intestinal BD recurrence after surgery. Methods: Fifty-four patients with intestinal BD who underwent surgery due to bowel complications and underwent follow-up colonoscopy were retrospectively investigated. Their clinical data, including colonoscopic findings, were retrieved. Classification and regression tree analysis was used to develop an appropriate endoscopic classification model that can explain the postsurgical recurrence of intestinal BD most accurately based on the following classification: e0, no lesions; e1, solitary ulcer <20 mm in size; e2, solitary ulcer ≥20 mm in size; and e3, multiple ulcers regardless of size. Results: Clinical relapse occurred in 37 patients (68.5%). Among 38 patients with colonoscopic recurrence, only 29 patients had clinically relapsed. Multivariate analysis identified higher disease activity index for intestinal BD at colonoscopy (hazard ratio [HR], 1.013; 95% confidence interval [CI], 1.005 to 1.021; p=0.002) and colonoscopic recurrence (HR, 2.829; 95% CI, 1.223 to 6.545; p=0.015) as independent risk factors for clinical relapse of intestinal BD. Endoscopic findings were classified into four groups, and multivariate analysis showed that the endoscopic score was an independent risk factor of clinical relapse (p=0.012). The risk of clinical relapse was higher in the e3 group compared to the e0 group (HR, 6.284; 95% CI, 2.036 to 19.391; p=0.001). Conclusions: This new endoscopic scoring system could predict clinical relapse in patients after surgical resection of intestinal BD.
Abstract
Background/Aims: The cumulative surgery rate and postoperative relapse of intestinal Behçet’s disease (BD) have been reported to be high. This study aimed to establish a scoring system based on follow-up endoscopic findings that can predict intestinal BD recurrence after surgery. Methods: Fifty-four patients with intestinal BD who underwent surgery due to bowel complications and underwent follow-up colonoscopy were retrospectively investigated. Their clinical data, including colonoscopic findings, were retrieved. Classification and regression tree analysis was used to develop an appropriate endoscopic classification model that can explain the postsurgical recurrence of intestinal BD most accurately based on the following classification: e0, no lesions; e1, solitary ulcer <20 mm in size; e2, solitary ulcer ≥20 mm in size; and e3, multiple ulcers regardless of size. Results: Clinical relapse occurred in 37 patients (68.5%). Among 38 patients with colonoscopic recurrence, only 29 patients had clinically relapsed. Multivariate analysis identified higher disease activity index for intestinal BD at colonoscopy (hazard ratio [HR], 1.013; 95% confidence interval [CI], 1.005 to 1.021; p=0.002) and colonoscopic recurrence (HR, 2.829; 95% CI, 1.223 to 6.545; p=0.015) as independent risk factors for clinical relapse of intestinal BD. Endoscopic findings were classified into four groups, and multivariate analysis showed that the endoscopic score was an independent risk factor of clinical relapse (p=0.012). The risk of clinical relapse was higher in the e3 group compared to the e0 group (HR, 6.284; 95% CI, 2.036 to 19.391; p=0.001). Conclusions: This new endoscopic scoring system could predict clinical relapse in patients after surgical resection of intestinal BD.
참고문헌 (26)
- Kaklamani VG, "Behçet’s disease", Semin Arthritis Rheum, 27, pp.197~217 (1998)
- Sakane T, "Behçet’s disease", N Engl J Med, 341, pp.1284~1291 (1999)
- Cheon JH, "Development and validation of novel diagnostic criteria for intestinal Behçet’s disease in Korean patients with ileocolonic ulcers", Am J Gastroenterol, 104, pp.2492~2499 (2009)
- Kobayashi K, "Development of consensus statements for the diagnosis and management of intestinal Behçet’s disease using a modified Delphi approach", J Gastroenterol, 42, pp.737~745 (2007)
- Kurata M, "Indications for surgery in intestinal Behçet’s disease", Hepatogastroenterology, 53, pp.60~63 (2006)
- Ketch LL, "Surgical implications of Behçet’s disease", Arch Surg, 115, pp.759~760 (1980)
- Jung YS, "Clinical course of intestinal Behcet’s disease during the first five years", Dig Dis Sci, 58, pp.496~503 (2013)
- Rutgeerts P, "Predictability of the postoperative course of Crohn’s disease", Gastroenterology, 99, pp.956~963 (1990)
- Schwartz M, "Prevention and treatment of postoperative Crohn’s disease recurrence: an update for a new decade", Curr Gastroenterol Rep, 13, pp.95~100 (2011)
- Cheon JH, "Development, validation, and responsiveness of a novel disease activity index for intestinal Behçet’s disease", Inflamm Bowel Dis, 17, pp.605~613 (2011)
- Breiman L, "Classification and regression trees" (1984), Chapman and Hall
- Steinberg D, "CART: Classification And Regression Trees" (1997), Salford Systems
- Bayraktar Y, "Gastrointestinal manifestations of Behcet’s disease", J Clin Gastroenterol, 30 (2000)
- Ebert EC, "Gastrointestinal manifestations of Behçet’s disease", Dig Dis Sci, 54, pp.201~207 (2009)
- Kasahara Y, "Intestinal involvement in Behçet’s disease: review of 136 surgical cases in the Japanese literature", Dis Colon Rectum, 24, pp.103~106 (1981)
- Baek SJ, "Surgical treatment and outcomes in patients with intestinal Behçet disease: long-term experience of a single large-volume center", Dis Colon Rectum, 58, pp.575~581 (2015)
- Choi IJ, "Long-term clinical course and prognostic factors in intestinal Behçet’s disease", Dis Colon Rectum, 43, pp.692~700 (2000)
- Iida M, "Postoperative recurrence in patients with intestinal Behçet’s disease", Dis Colon Rectum, 37, pp.16~21 (1994)
- Naganuma M, "Analysis of clinical course and long-term prognosis of surgical and nonsurgical patients with intestinal Behçet’s disease", Am J Gastroenterol, 95, pp.2848~2851 (2000)
- Jung YS, "Prognostic factors and long-term clinical outcomes for surgical patients with intestinal Behcet’s disease", Inflamm Bowel Dis, 17, pp.1594~1602 (2011)
- Chung MJ, "Response rates to medical treatments and long-term clinical outcomes of nonsurgical patients with intestinal Behçet disease", J Clin Gastroenterol, 44, pp.e116~e122 (2010)
- Kim JS, "Prediction of the clinical course of Behçet’s colitis according to macroscopic classification by colonoscopy", Endoscopy, 32, pp.635~640 (2000)
- Moon CM, "Prediction of free bowel perforation in patients with intestinal Behçet’s disease using clinical and colonoscopic findings", Dig Dis Sci, 55, pp.2904~2911 (2010)
- Rutgeerts P, "Mucosal healing in inflammatory bowel disease: impossible ideal or therapeutic target", Gut, 56, pp.453~455 (2007)
- Frøslie KF, "Mucosal healing in inflammatory bowel disease: results from a Norwegian population-based cohort", Gastroenterology, 133, pp.412~422 (2007)
- Yim SM, "Mucosal healing predicts the long-term prognosis of intestinal Behçet’s disease", Dig Dis Sci, 59, pp.2529~2535 (2014)