{"id":1649,"date":"2021-04-20T09:00:42","date_gmt":"2021-04-20T09:00:42","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/pt\/?p=1649"},"modified":"2022-06-17T12:48:15","modified_gmt":"2022-06-17T12:48:15","slug":"caso-clinico-tratamento-de-fistula-de-gastroenteroanastomose-pos-bypass-gastrico-em-y-de-roux-2","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/caso-clinico-tratamento-de-fistula-de-gastroenteroanastomose-pos-bypass-gastrico-em-y-de-roux-2\/","title":{"rendered":"Escores endosc\u00f3picos em doen\u00e7a inflamat\u00f3ria: voc\u00ea utiliza de rotina?"},"content":{"rendered":"

Pacientes com <\/span>doen\u00e7a de Crohn<\/span><\/a> (DC) e retocolite ulcerativa (RCU) apresentam uma baixa correla\u00e7\u00e3o entre a apresenta\u00e7\u00e3o de sintomas e a atividade inflamat\u00f3ria da doen\u00e7a. Al\u00e9m do mais, sabe-se que a adequada cicatriza\u00e7\u00e3o mucosa tem se associado com respostas cl\u00ednicas sustentadas, redu\u00e7\u00e3o de uso de corticosteroides, redu\u00e7\u00e3o de hospitaliza\u00e7\u00f5es, e mesmo de cirurgias, e c\u00e2ncer colorretal.<\/span><\/p>\n

Com isso, para manejo dos quadros, faz-se necess\u00e1rio o uso de m\u00faltiplos recursos, como exames laboratoriais, provas inflamat\u00f3rias s\u00e9ricas, calprotectina fecal, exames de imagem e particularmente os m\u00e9todos endosc\u00f3picos.<\/span><\/p>\n

Ao longo dos anos, diversos escores endosc\u00f3picos foram desenvolvidos para DC e RCU, principalmente no escopo de estudos cl\u00ednicos, com o intuito de promover melhor capacidade de avalia\u00e7\u00e3o e resposta aos tratamentos.<\/span><\/p>\n

Fora do ambiente cient\u00edfico de pesquisas cl\u00ednicas, contudo, os escores endosc\u00f3picos acabam sendo menos utilizados, entre outros motivos, pela complexidade e d\u00favidas impostas na sua aplica\u00e7\u00e3o.<\/span><\/p>\n

Sabe-se, por\u00e9m, que a objetividade, uniformidade e padroniza\u00e7\u00e3o que a utiliza\u00e7\u00e3o de escores promove podem ser de grande aux\u00edlio, permitindo descri\u00e7\u00f5es mais precisas dos achados endosc\u00f3picos, potencial benef\u00edcio na tomada de decis\u00e3o baseada em alvos terap\u00eauticos e, por consequ\u00eancia, dos resultados cl\u00ednicos desej\u00e1veis.<\/span><\/p>\n

Escores endosc\u00f3picos em RCU<\/b><\/h2>\n

Diversos escores endosc\u00f3picos para RCU foram desenvolvidos ao longo do tempo, com a inclus\u00e3o dos mais variados descritores, incluindo altera\u00e7\u00f5es do padr\u00e3o vascular, granularidade, edema de mucosa, exsudato mucopurulento, sangramento, friabilidade, eros\u00f5es e ulcera\u00e7\u00f5es. Contudo, o escore de Mayo [tabela 1] continua sendo o mais utilizado nesses casos. A cicatriza\u00e7\u00e3o de mucosa \u00e9 definida como escore 0\u20131, embora de forma n\u00e3o validada.<\/span><\/p>\n

\"\"<\/a><\/p>\n

Figura 1. Aspectos endosc\u00f3picos Mayo 0 – 4<\/p>\n

\"\"<\/a><\/p>\n

Tabela 1. Escore de Mayo<\/p>\n

O <\/span>escore de Mayo<\/span><\/a> tem como vantagens a facilidade no seu uso e a grande frequ\u00eancia de utiliza\u00e7\u00e3o em trabalhos cient\u00edficos. Como limita\u00e7\u00f5es, podem ser citadas a falta de valida\u00e7\u00e3o, a incapacidade de distin\u00e7\u00e3o entre \u00falceras superficiais e profundas e a classifica\u00e7\u00e3o baseada no segmento do c\u00f3lon pior avaliado em atividade.<\/span><\/p>\n

Escores endosc\u00f3picos em DC<\/b><\/h2>\n

Entre os \u00edndices endosc\u00f3picos mais utilizados para avalia\u00e7\u00e3o da DC, citamos: \u201cCrohn\u2019s Disease Endoscopic Index of Severity\u201d (CDEIS) [tabela 2], \u201cSimple Endoscopic Score for Crohn\u00b4s Disease\u201d (SES-CD) [tabela 3] e o escore p\u00f3s-operat\u00f3rio de Rutgeerts [tabela 4].<\/span><\/p>\n

O CDEIS \u00e9 um escore bastante detalhado que divide a avalia\u00e7\u00e3o endosc\u00f3pica em 5 segmentos (\u00edleo, c\u00f3lon direito, transverso, esquerdo, incluindo sigmoide, e reto), conferindo a descri\u00e7\u00e3o de les\u00f5es mucosas, ulcera\u00e7\u00f5es e estenoses de cada segmento, computando dados de forma complexa para um \u00edndice final que varia de 0 a 44.<\/span>\"\"<\/a><\/p>\n

Tabela 2. Crohn’s Disease Endoscopic Index of Severity (CDEIS)<\/p>\n

Embora os par\u00e2metros de remiss\u00e3o usando o CDEIS n\u00e3o estejam formalmente validados, a resposta endosc\u00f3pica tem sido considerada em valores menores do que 3\u20135 pontos.<\/span><\/p>\n

O SES-CD foi desenvolvido como uma simplifica\u00e7\u00e3o do CDEIS. Ele inclui quatro vari\u00e1veis (tamanho da \u00falcera, extens\u00e3o da superf\u00edcie ulcerada, extens\u00e3o da superf\u00edcie afetada e estenose) em 5 segmentos do c\u00f3lon.<\/span><\/p>\n

\"\"<\/a><\/p>\n

Tabela 3. Simple Endoscopic Score for Crohn\u00b4s Disease<\/p>\n

O SES-CD apresenta boa correla\u00e7\u00e3o com o CDEIS, e alguns estudos cl\u00ednicos t\u00eam definido remiss\u00e3o quando o escore se apresenta < 3 (valores variados s\u00e3o descritos).<\/span><\/p>\n

O SES-CD parece ser de mais simples execu\u00e7\u00e3o, permitindo um uso cl\u00ednico mais rotineiro que o CDEIS.<\/span><\/p>\n

O escore de Rutgeerts \u00e9 usado para a grada\u00e7\u00e3o de les\u00f5es no neo\u00edleo terminal e anastomose ap\u00f3s ressec\u00e7\u00f5es ileocol\u00f4nicas e j\u00e1 foi discutido anteriormente por <\/span>aqui.<\/span><\/a><\/p>\n

\"\"<\/a><\/p>\n

Figura 2. Imagens ilustrando escore de Rutgeerts<\/p>\n

 <\/p>\n

\"\"<\/a><\/p>\n

Tabela 4. Escore de Rutgeerts<\/p>\n

Coment\u00e1rios<\/b><\/h2>\n

A evolu\u00e7\u00e3o nos paradigmas de tratamento da RCU e DC com objetivos cada vez mais direcionados \u00e0 cicatriza\u00e7\u00e3o da mucosa, e n\u00e3o somente controle cl\u00ednico, tem levado \u00e0 necessidade de melhor parametriza\u00e7\u00e3o e objetividade na descri\u00e7\u00e3o endosc\u00f3pica. O uso de escores endosc\u00f3picos auxilia nesse cen\u00e1rio e se faz interessante na pr\u00e1tica. Os escores endosc\u00f3picos que utilizamos de modo mais corriqueiro atualmente n\u00e3o s\u00e3o perfeitos, alguns apresentam-se de forma mais simples e at\u00e9 limitada, outros com complexidade excessiva na sua elabora\u00e7\u00e3o. Contudo, acredito na import\u00e2ncia da aplica\u00e7\u00e3o cl\u00ednica dos escores endosc\u00f3picos, conferindo melhor controle evolutivo dos casos, e fa\u00e7o uso deles na minha pr\u00e1tica cl\u00ednica. E voc\u00eas, o que pensam?<\/span><\/p>\n

Como citar este artigo<\/h3>\n

Medrado B. Escores endosc\u00f3picos em doen\u00e7a inflamat\u00f3ria: voc\u00ea utiliza de rotina? Endoscopia Terap\u00eautica; 2021. Dispon\u00edvel em: <\/span>https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/escores-endoscopicos-em-doenca-inflamatoria-voce-utiliza-de-rotina\/<\/span><\/p>\n

Refer\u00eancias<\/h3>\n
    \n
  1. Limdi JK, Picco M, Farraye FA, A Review of endoscopic scoring systems and their importance in a \u201ctreat to target\u201d approach in inflammatory bowel disease. Gastrointestinal Endoscopy (2019)<\/span><\/li>\n
  2. Torres J, Mehandru S, Colombel JF, Peyrin-Biroulet L. Crohn\u2019s disease. Lancet.2017;389:1741-55. Ungaro R, Mehandru S, Allen PB, Peyrin-Biroulet L, Colombel JF. Ulcerative colitis. Lancet. 2017;389:1756-70.<\/span><\/li>\n
  3. Peyrin-Biroulet L, Panes J, Sandborn WJ, Vermeire S, Danese S, Feagan BG, et al. Defining Disease Severity in Inflammatory Bowel Diseases: Current and Future Directions. Clin Gastroenterol Hepatol. 2016;14:348-54 e17.<\/span><\/li>\n
  4. Rutgeerts P, Sandborn WJ, Feagan BG, Reinisch W, Olson A, Johanns J, et al.Infliximab for induction and maintenance therapy for ulcerative colitis. N Engl J Med. 2005;353:2462-76.<\/span><\/li>\n<\/ol>\n

    Acesse o <\/span>Endoscopia Terap\u00eautica<\/span><\/a> para tomar contato com mais <\/span>artigos comentados<\/span><\/a>, <\/span>assuntos gerais<\/span><\/a>, <\/span>casos cl\u00ednicos<\/span><\/a>, <\/span>quizzes<\/span><\/a>, <\/span>classifica\u00e7\u00f5es<\/span><\/a> e mais!<\/span> <\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

    Pacientes com doen\u00e7a de Crohn (DC) e retocolite ulcerativa (RCU) apresentam uma baixa correla\u00e7\u00e3o…<\/p>\n","protected":false},"author":726,"featured_media":5430,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[151],"tags":[],"ano":[262],"tipo":[156],"volume":[263],"class_list":["post-1649","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-assuntosgerais","ano-262","tipo-colonoscopia","volume-volume-i"],"yoast_head":"\nEscores endosc\u00f3picos em doen\u00e7a inflamat\u00f3ria: voc\u00ea utiliza de rotina? • Endoscopia Terapeutica<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" 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