The Clinical Significance of Anastomotic Ulcers After Ileocolic Resection to Predict Postoperative Recurrence of Crohn’s Disease
Background The Rutgeerts score is used to predict postoperative recurrence in CD patients after ileocolic resection and is primarily based on endoscopic findings at the neoterminal ileum. However, the optimal assessment of anastomotic ulcers (AUs) remains subject to debate. Aims We aimed to investigate the association between anastomotic ulcers (AUs) and endoscopic recurrence in postoperative Crohn’s disease (CD) patients. Methods This single-center retrospective study, conducted between 2000 and 2016, evaluated postoperative CD patients with endoscopic remission at the first ileocolonoscopy within 1 year after ileocolic resection and those who underwent subsequent ileocolonoscopic follow-up. The study outcome was the clinical significance of AUs in predicting endoscopic recurrence. Results Among 116 patients who were in endoscopic remission defined as the RS of i0 to i1 at the index postoperative ileocolonoscopy, 84.5% (98/116) underwent subsequent ileocolonoscopies. During the median 30.0 months (interquartile range, 21.3–53.3) of follow-up after the first ileocolonoscopy, 56.1% (55/98) of patients showed endoscopic recurrence. Furthermore, 65.8% (48/73) with AUs and 75.5% (40/53) with major AUs, defined as either an ulcer occupying ≥ 1/4 of the circumference, ≥ 3 ulcers confined to anastomotic ring, or any ulcers extending to the ileocolonic mucosa, showed endoscopic recurrence. On multivariable analysis, AUs (adjusted hazard ratio [aHR], 4.33; 95% confidence interval [CI], 1.87–10.0; P < 0.001) and major AUs (aHR, 3.64; 95% CI, 1.95–79; P < 0.001) were associated with endoscopic recurrence. Conclusions AUs are associated with a significantly high risk of endoscopic recurrence in postoperative CD patients who are in endoscopic remission..
| Medienart: |
Artikel |
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| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:66 |
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| Enthalten in: |
Digestive diseases and sciences - 66(2020), 9 vom: 14. Sept., Seite 3132-3140 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Kim, Jin Yong [VerfasserIn] |
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| Links: |
Volltext [lizenzpflichtig] |
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| Anmerkungen: |
© Springer Science+Business Media, LLC, part of Springer Nature 2020 |
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| doi: |
10.1007/s10620-020-06599-3 |
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OLC2127331117 |
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| 520 | |a Background The Rutgeerts score is used to predict postoperative recurrence in CD patients after ileocolic resection and is primarily based on endoscopic findings at the neoterminal ileum. However, the optimal assessment of anastomotic ulcers (AUs) remains subject to debate. Aims We aimed to investigate the association between anastomotic ulcers (AUs) and endoscopic recurrence in postoperative Crohn’s disease (CD) patients. Methods This single-center retrospective study, conducted between 2000 and 2016, evaluated postoperative CD patients with endoscopic remission at the first ileocolonoscopy within 1 year after ileocolic resection and those who underwent subsequent ileocolonoscopic follow-up. The study outcome was the clinical significance of AUs in predicting endoscopic recurrence. Results Among 116 patients who were in endoscopic remission defined as the RS of i0 to i1 at the index postoperative ileocolonoscopy, 84.5% (98/116) underwent subsequent ileocolonoscopies. During the median 30.0 months (interquartile range, 21.3–53.3) of follow-up after the first ileocolonoscopy, 56.1% (55/98) of patients showed endoscopic recurrence. Furthermore, 65.8% (48/73) with AUs and 75.5% (40/53) with major AUs, defined as either an ulcer occupying ≥ 1/4 of the circumference, ≥ 3 ulcers confined to anastomotic ring, or any ulcers extending to the ileocolonic mucosa, showed endoscopic recurrence. On multivariable analysis, AUs (adjusted hazard ratio [aHR], 4.33; 95% confidence interval [CI], 1.87–10.0; P < 0.001) and major AUs (aHR, 3.64; 95% CI, 1.95–79; P < 0.001) were associated with endoscopic recurrence. Conclusions AUs are associated with a significantly high risk of endoscopic recurrence in postoperative CD patients who are in endoscopic remission. | ||
| 650 | 4 | |a Crohn’s disease | |
| 650 | 4 | |a Recurrence | |
| 650 | 4 | |a Ulcer | |
| 700 | 1 | |a Park, Sang Hyoung |4 aut | |
| 700 | 1 | |a Park, Jae Cheol |4 aut | |
| 700 | 1 | |a Noh, Soomin |4 aut | |
| 700 | 1 | |a Lee, Jung Su |4 aut | |
| 700 | 1 | |a Kim, Jeongseok |4 aut | |
| 700 | 1 | |a Ham, Nam Seok |4 aut | |
| 700 | 1 | |a Oh, Eun Hye |4 aut | |
| 700 | 1 | |a Hwang, Sung Wook |4 aut | |
| 700 | 1 | |a Yang, Dong-Hoon |4 aut | |
| 700 | 1 | |a Ye, Byong Duk |4 aut | |
| 700 | 1 | |a Byeon, Jeong-Sik |4 aut | |
| 700 | 1 | |a Myung, Seung-Jae |4 aut | |
| 700 | 1 | |a Lee, Jong Lyul |4 aut | |
| 700 | 1 | |a Yoon, Yong Sik |4 aut | |
| 700 | 1 | |a Yu, Chang Sik |4 aut | |
| 700 | 1 | |a Yang, Suk-Kyun |4 aut | |
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