Ileal or Anastomotic Location of Lesions Does Not Impact Rate of Postoperative Recurrence in Crohn’s Disease Patients Classified i2 on the Rutgeerts Score

• Published in: Digestive diseases and sciences 2016-10, Vol.61 (10), p.2986-2992
• Main Authors: Bayart, P., Duveau, N., Nachury, M., Zerbib, P., Gerard, R., Branche, J., Maunoury, V., Wils, Pauline, Boruchowicz, A., Boualit, M., Laberenne, J.-E., Manolache, O., Desreumaux, P., de Chambrun, G. Pineton, Pariente, B.
• Format: Article
• Language: English
• Subjects: Adult; Anastomosis, Surgical; Biochemistry; Colon - pathology; Colon - surgery; Colonoscopy; Constriction, Pathologic - etiology; Constriction, Pathologic - surgery; Crohn Disease - complications; Crohn Disease - pathology; Crohn Disease - surgery; Diseases; Female; Gastroenterology; Hepatology; Human health and pathology; Humans; Hépatology and Gastroenterology; Ileum - pathology; Ileum - surgery; Intestinal Obstruction - etiology; Intestinal Obstruction - surgery; Intestinal Perforation - etiology; Intestinal Perforation - surgery; Life Sciences; Male; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Oncology; Original Article; Pneumoviridae; Postoperative Period; Prognosis; Recurrence; Relapse; Retrospective Studies; Transplant Surgery
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-016-4215-1

Background The Rutgeerts score with 5 grades of severity (i0–i4) is a suitable endoscopic model to predict clinical recurrence following ileocolonic resection in Crohn’s disease (CD). Definition of grade i2 includes lesions confined to the ileocolonic anastomosis (i2a) or moderate lesions on the neo-terminal ileum (i2b). The aim of the present study was to evaluate the probability of clinical recurrence in i2a and i2b patients. Methods This multicenter retrospective study included all CD patients classified i2 at the first postoperative ileocolonoscopy. The primary outcome was to evaluate the probability of clinical recurrence in patients classified i2a and i2b. The secondary outcome was to compare the rate of global recurrence of CD. Results Fifty patients were included: 23 were classified i2a and 27 were classified i2b. The median duration of follow-up was 40 (18.0–80.4) months in the i2a group and 53.5 (25.0–69.0) months in the i2b group ( p  = 0.9). The probability of clinical recurrence was not significantly different between patients classified i2a and i2b ( p  = 0.64). Median time to clinical recurrence after the first ileocolonoscopy and probability of global CD recurrence were not different between the two groups ( p  ≥ 0.19). Conclusions The rate of clinical postoperative recurrence is not different in i2a and i2b patients. These results suggest that the same therapeutic strategy should be used in all patients classified i2 on the Rutgeerts score whatever the location of postoperative CD recurrence.