BACKGROUND AND AIMS It is standard of care to perform ileocolonoscopy within a year of ileocolonic resection for Crohn's disease (CD) and to guide management decisions based on the Rutgeert score (RS). The modified RS subdivides i2 into lesions confined to the anastomosis (i2a) or >5 aphthous lesions in the neoterminal ileum (i2b). There is uncertainty, however, if i2a lesions incur an increased risk of disease recurrence. The primary aim of this study was to compare the rates of endoscopic progression between i2a and i2b when compared with i0-i1. METHODS This was a retrospective, single-center study including patients with CD who had an ileocolonoscopy ≤12 months after ileocolonic resection with primary anastomosis and who had >1 year of documented clinical follow-up after the index endoscopic evaluation. All consecutive eligible patients between 2004 and 2014 were included in the study. Demographic, disease, and treatment data were collected. Patients with i3 or i4 at index colonoscopy were excluded from further analyses. Outcomes included endoscopic progression and recurrent surgery. For patients with RS of i0 to i2, endoscopic progression was predefined as progression of the RS in subsequent colonoscopies to i3 or i4. Recurrent surgical interventions were defined as re-resection or stricturoplasty of the previous ileocolonic anastomosis. RESULTS Two hundred seven CD patients (median age, 36 years [interquartile range, 26-48]) had an ileocolonoscopy ≤12 months after ileocolonic resection. At index colonoscopy, 95 patients (45.9%) had an RS of i0, 31 (14.9%) i1, 40 (19.3%) i2a, 25 (12.1%) i2b, 10 (4.8%) i3, and 6 (2.9%) i4. One hundred ninety-one patients had an RS of i0 to i2 and were included in the analyses for recurrent surgery. One hundred forty-nine patients had a second endoscopic evaluation and were included in the analysis for the primary outcome of endoscopic disease progression. Kaplan-Meier analyses were performed and found the hazard ratio (HR) of endoscopic progression to be significantly higher with i2b lesions when compared with i0 or i1 (HR, 6.22; 95% confidence interval [CI], 2.38-16.2; P = .0008). Patients with i2a did not have significantly higher rates of endoscopic progression when compared with i0 or i1 (HR, 2.30; 95% CI, .80-6.66; P = .12). Likewise, patients with i2b lesions had higher risk of needing recurrent surgery when compared with i0 or i1 (HR, 3.64; 95% CI, 1.10-12.1; P = .034), whereas patients with i2a lesions were not found to have a significantly elevated risk of recurrent surgery (HR, 1.43; 95% CI, .35-5.77; P = .62). CONCLUSION Endoscopic lesions limited to the ileocolonic anastomosis (RS i2a) in patients with CD undergoing colonoscopy within 1 year of their resection were not associated with a significantly higher rate of progression to more severe disease, whereas those in the neoileum (RS i2b) were. Prospective studies are needed to confirm these findings.

中文翻译：

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克罗恩病患者在孤立的吻合口溃疡和回肠结肠切除后轻度回肠复发之间疾病发展的风险差异。

背景和目的在克罗恩病（CD）的回肠结肠切除术后的一年内进行回肠结肠镜检查，并根据Rutgeert评分（RS）指导管理决策是一项护理标准。改良的RS将i2细分为局限于吻合口的病变（i2a）或新末端回肠中的> 5口疮性病变（i2b）。但是，如果i2a病变引起疾病复发的风险增加，则存在不确定性。这项研究的主要目的是比较与i0-i1相比i2a和i2b之间的内镜进展率。方法这是一项回顾性，单中心研究，包括患有CD的患者，这些患者在接受结肠结肠镜切除术并进行原发性吻合术后接受结肠镜检查≤12个月，并且在进行了索引内窥镜评估后已进行了1年以上的临床随访。研究纳入了2004年至2014年期间的所有连续合格患者。收集了人口，疾病和治疗数据。在索引结肠镜检查中患有i3或i4的患者被排除在进一步分析之外。结果包括内窥镜进展和复发性手术。对于RS从i0到i2的患者，内窥镜检查的进展预定义为随后的结肠镜检查到i3或i4的RS的进展。复发性外科手术的定义为对先前的结肠结肠吻合术进行再次切除或严格尿道成形术。结果27例CD患者（中位年龄36岁[四分位间距26-48岁]）在进行回结肠结肠切除术后≤12个月进行了结肠镜检查。在结肠镜检查中，有95例患者（45.9％）的RS为i0、31（14.9％）i1、40（19.3％）i2a，25（12.1％）i2b，10（4.8％）i3和6（2.9％） i4。191例患者的RS为i0到i2，并包括在复发性手术分析中。一百四十九名患者接受了第二次内镜评估，并被纳入分析内镜疾病进展的主要结局。进行了Kaplan-Meier分析，发现与i0或i1相比，i2b病变的内镜进展风险比（HR）显着更高（HR，6.22； 95％置信区间[CI]，2.38-16.2； P =。 0008）。与i0或i1相比，i2a患者的内镜进展率没有明显提高（HR，2.30； 95％CI，.80-6.66； P = .12）。同样，与i0或i1相比，具有i2b病变的患者需要再次手术的风险更高（HR，3.64； 95％CI，1.10-12.1； P = .034），而没有发现具有i2a病变的患者再次手术的风险显着升高（HR，1.43； 95％CI，.35-5.77； P = .62）。结论在切除术后1年内接受结肠镜检查的CD患者中，仅限于回结肠结肠吻合术（RS i2a）的内镜病变与进展为更严重疾病的发生率没有显着相关，而在新回肠（RS i2b）中则如此。需要进行前瞻性研究以证实这些发现。而那些在新回肠（RS i2b）中的则是。需要进行前瞻性研究以证实这些发现。而那些在新回肠（RS i2b）中的则是。需要进行前瞻性研究以证实这些发现。