Background

Early ileocolonoscopy within the first year after surgery is the gold standard to evaluate post-operative recurrence after ileocolonic resection for Crohn’s disease (CD). The aim of the study was to evaluate the association between lesions at ileocolonoscopy 6 months after surgery and long-term outcomes.

Methods

The REMIND group conducted a prospective multicentre study. Patients operated for ileal or ileocolonic CD were included. An ileocolonoscopy was performed 6 months after surgery. An endoscopic classification separating anastomotic and ileal lesions was built (Ax for anastomotic lesions; Ix for neo-terminal ileum lesions evaluated according to the Rutggerts score). Clinical relapse was defined by CD-related symptoms confirmed by imaging, endoscopy or therapeutic intensification, CD-related complication or subsequent surgery.

Results

A total of 225 patients were included. Long-term data were available for 193 patients (86%). Median follow-up was 3.82 years (IQR:2.56–5.41) from surgery. Median clinical recurrence-free survival was 47.6 months. Clinical recurrence-free survival was significantly shorter in patients with ileal lesions at early post-operative endoscopy whatever their severity (I1 or I2I3I4) compared with patients without (I0) (median survivals: 68.5, 33.0 and 39.1 months, respectively, for I0, I1 and I2I3I4; I0 vs. I2I3I4: p = 0.0003; I0 vs. I1: p = 0.0008 and I1 vs. I2I3I4: p = 0.43). Patients with at least semi-circumferential anastomotic ulcerations (A2 or A3) had more anastomotic occlusive manifestations than patients without (A0 or A1) (A0 vs. A2A3: p = 0.01; A0 vs. A1: p = 0.83; A1 vs. A2A3: p = 0.05).

Conclusion

A classification separating anastomotic and ileal lesions might be more appropriate to define post-operative endoscopic recurrence. Patients with ileal lesions, including mild ones (I1), could beneficiate from treatment step up to improve long-term outcome.

中文翻译：

---

OP04根据早期内镜复发的严重程度，在克罗恩病中进行结肠结肠切除术后长期结局

背景

术后第一年内进行早期结肠镜检查是评估结肠结肠切除术克罗恩病（CD）术后复发率的金标准。这项研究的目的是评估术后6个月的回肠结肠镜检查病变与长期预后之间的关系。

方法

REMIND小组进行了一项前瞻性多中心研究。包括接受回肠或回结肠CD手术的患者。术后6个月进行结肠镜检查。建立了将吻合口和回肠病变分开的内窥镜分类法（对吻合口病变采用Ax；对新末期回肠病变采用Ix根据Rutggerts评分进行评估）。临床复发的定义是通过影像学，内窥镜检查或治疗强化，CD相关并发症或随后的手术证实的CD相关症状。

结果

总共包括225名患者。可获得193位患者（86％）的长期数据。手术后的中位随访时间为3.82年（IQR：2.56-5.41）。临床无复发生存期中位数为47.6个月。无论其严重程度（I1或I2I3I4），在术后早期内镜下有回肠病变的患者的临床无复发生存期明显短于没有（I0）的患者（中位生存期分别为68.5、33.0和39.1个月）。 I1和I2I3I4； I0对I2I3I4：p = 0.0003； I0对I1：p = 0.0008； I1对I2I3I4：p = 0.43）。至少有半周吻合溃疡的患者（A2或A3）比没有吻合术的患者（A0或A1）具有更多的吻合闭塞表现（A0对A2A3：p = 0.01； A0对A1：p = 0.83； A1对A2A3 ：p ＝ 0.05）。

结论

分离吻合口和回肠病变的分类可能更适合定义术后内镜复发。回肠病变的患者，包括轻度回肠病变（I1），可从治疗逐步受益，以改善长期预后。