Postoperative Endoscopic Recurrence of Ileal Lesions, Not Anastomotic Lesions, More Likely to Predict Long-Term Outcomes in Crohn’s Disease
Monika Fischer, MD, reviewing Hammoudi N, et al. Am J Gastroenterol 2020 May 22.
Early endoscopic recurrence of Crohn’s disease (CD) following ileocolonic resection predicts clinical recurrence, the need for therapy escalation, and repeat surgery. The significance of mild endoscopic disease recurrence in the neoterminal ileum and/or at the ileocolonic anastomosis is debated.
In a prospective, multicenter French study, 193 patients were followed long term (median follow-up, 3.82 years [interquartile range, 2.56–5.41]). A new endoscopic scoring system that describes the anastomotic and ileal lesions separately was applied at ileocolonoscopy performed 6 months after surgery. Patients with ileal lesions, irrespective of severity, relapsed significantly faster than patients with no ileal lesions or patients with lesions limited to the anastomosis only. Patients with anastomotic ulcerations involving more than half of the circumference had a significant increase of occlusive anastomotic complications but only a trend toward a poorer long-term clinical outcome.
COMMENTEarlier publications concluded that patients with mild endoscopic recurrence (i1, <5 apthous ulcers) within the first year after ileocolonic resection have similar long-term outcomes compared to patients with no endoscopic lesions and might be fine with just observation and no therapy. This large prospective study suggests that patients with ileal lesions of any severity should be considered for therapy escalation or optimization to avoid disease progression. Lesions restricted to the ileocolonic anastomosis, on the other hand, have a lesser impact. Therefore, separate evaluation of endoscopic recurrence in the neoterminal ileum and on the ileocolonic anastomosis makes a lot of sense and should guide therapy.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Hammoudi N, Auzolle C, Tran Minh ML, et al. Postoperative endoscopic recurrence on the neoterminal ileum but not on the anastomosis is mainly driving long-term outcomes in Crohn’s disease. Am J Gastroenterol 2020 May 22. (Epub ahead of print) (https://doi.org/10.14309/ajg.0000000000000638)
