Association Between Microscopic Lesions at Ileal Resection Margin and Recurrence After Surgery in Patients With Crohn's Disease.
IBD Surgery
Outcome
Prognostic Factor
REMIND Trial
Journal
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
ISSN: 1542-7714
Titre abrégé: Clin Gastroenterol Hepatol
Pays: United States
ID NLM: 101160775
Informations de publication
Date de publication:
01 2020
01 2020
Historique:
received:
06
02
2019
revised:
04
04
2019
accepted:
19
04
2019
pubmed:
3
5
2019
medline:
28
5
2021
entrez:
3
5
2019
Statut:
ppublish
Résumé
Different types of histologic lesions at the ileal margin, detected by histology, have been associated with increased rates of recurrence after ileocaecal surgery in patients with Crohn's disease (CD). We aimed to characterize histologic features of the ileal margin and to evaluate their association with disease recurrence. We collected histologic data from 211 patients with ileal or ileocolonic CD who underwent ileocolonic resections at hospitals in France from September 2010 through December 2016. Ileal margins were analyzed. Early endoscopic recurrence was defined by a Rutgeerts score of i2 or more, 6 months after surgery. We also collected data from 10 adults with healthy ileum who underwent ileocecal resection for colonic tumors (controls). Clinical relapse was defined by CD-related symptoms confirmed by imaging, endoscopy, therapy intensification, CD-related complication, or subsequent surgery. Six months after surgery, 49% of patients had endoscopic recurrence; 5 years after surgery, 57% of patients had clinical relapse. Ileal margins were macroscopically affected in 20.9% of patients. CD transmural lesions at the margin (defined by mucosal ulceration or cryptitis, submucosal fibrosis and lymphoplasmacytic infiltrate of the subserosa) were observed in 13.6% of patients. Endoscopic recurrence was observed in 75% of patients with CD transmural lesions vs 46% of patients without (P =.005). In multivariate analysis, CD transmural lesions at the margin were independently associated with early endoscopic recurrence (OR, 3.83; 95% CI, 1.47-11.05; P =.008) and clinical recurrence (OR 2.04; 95% CI, 1.09-3.99; P =.026). In patients with CD, transmural lesions at the ileal margin were associated with an increased risk of post-operative recurrence. Histologic features of the ileal margin should be included in making decisions about post-operative therapy.
Sections du résumé
BACKGROUND AND AIMS
Different types of histologic lesions at the ileal margin, detected by histology, have been associated with increased rates of recurrence after ileocaecal surgery in patients with Crohn's disease (CD). We aimed to characterize histologic features of the ileal margin and to evaluate their association with disease recurrence.
METHODS
We collected histologic data from 211 patients with ileal or ileocolonic CD who underwent ileocolonic resections at hospitals in France from September 2010 through December 2016. Ileal margins were analyzed. Early endoscopic recurrence was defined by a Rutgeerts score of i2 or more, 6 months after surgery. We also collected data from 10 adults with healthy ileum who underwent ileocecal resection for colonic tumors (controls). Clinical relapse was defined by CD-related symptoms confirmed by imaging, endoscopy, therapy intensification, CD-related complication, or subsequent surgery.
RESULTS
Six months after surgery, 49% of patients had endoscopic recurrence; 5 years after surgery, 57% of patients had clinical relapse. Ileal margins were macroscopically affected in 20.9% of patients. CD transmural lesions at the margin (defined by mucosal ulceration or cryptitis, submucosal fibrosis and lymphoplasmacytic infiltrate of the subserosa) were observed in 13.6% of patients. Endoscopic recurrence was observed in 75% of patients with CD transmural lesions vs 46% of patients without (P =.005). In multivariate analysis, CD transmural lesions at the margin were independently associated with early endoscopic recurrence (OR, 3.83; 95% CI, 1.47-11.05; P =.008) and clinical recurrence (OR 2.04; 95% CI, 1.09-3.99; P =.026).
CONCLUSION
In patients with CD, transmural lesions at the ileal margin were associated with an increased risk of post-operative recurrence. Histologic features of the ileal margin should be included in making decisions about post-operative therapy.
Identifiants
pubmed: 31042575
pii: S1542-3565(19)30435-5
doi: 10.1016/j.cgh.2019.04.045
pii:
doi:
Types de publication
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
141-149.e2Investigateurs
Pierre Cattan
(P)
Mircea Chirica
(M)
Nicolas Munoz-Bongrand
(N)
Hélène Corte
(H)
Nathan Beaupel
(N)
Jonathan Catry
(J)
Jean-Marc Gornet
(JM)
Clotilde Baudry
(C)
Nelson Lourenco
(N)
Mariane Maillet
(M)
My-Linh Tran-Minh
(ML)
Victor Chardiny
(V)
Céline Grand
(C)
Brice Gergaud
(B)
Joelle Bonnet
(J)
Leila Chedouba
(L)
Andrée Nisard
(A)
Laurent Beaugerie
(L)
Harry Sokol
(H)
Anne Bourrier
(A)
Isabelle Nion-Larmurier
(I)
Julien Kirchgesner
(J)
Elodie Quevrain
(E)
Loic Brot
(L)
Najim Chafai
(N)
Jeremie H Lefevre
(JH)
Emmanuel Tiret
(E)
Magali Svrcek
(M)
Nathalie Guedj
(N)
Yves Panis
(Y)
Leon Magiorri
(L)
Marianne Ferron
(M)
Yoram Bouhnik
(Y)
Olivier Corcos
(O)
Carmen Stefanescu
(C)
Philippe Marteau
(P)
Xavier Dray
(X)
Ulrika Chaput
(U)
Rachid Kaci
(R)
Anne Dubois
(A)
Gilles Bommelaer
(G)
Marion Goutte
(M)
Nicolas Barnich
(N)
Dilek Coban
(D)
Catherine Godfraind
(C)
Juliette Joubert Zakeyh
(JJ)
Pierre Desreumaux
(P)
Maria Nachury
(M)
Coralie Sommeville
(C)
Florence Renaud
(F)
Jean-Louis Dupas
(JL)
Julien Loreau
(J)
Franck Brazier
(F)
Denis Chatelain
(D)
Christophe Attencourt
(C)
Charles Sabbagh
(C)
Martine Leconte
(M)
Gilles Boschetti
(G)
Bernard Flourié
(B)
Yves François
(Y)
Eddy Cotte
(E)
Anne-Laure Charlois
(AL)
Peggy Falgon
(P)
Helena Hadjisavvas
(H)
Driffa Moussata
(D)
Marion Chauvenet
(M)
Sarah Boyer
(S)
Alexandra Traverse-Glehen
(A)
Xavier Hebuterne
(X)
Jérome Filippi
(J)
Paul Hofmann
(P)
Amine Rahili
(A)
Stéphanie Patouraux
(S)
Xavier Jouven
(X)
Informations de copyright
Copyright © 2020 AGA Institute. Published by Elsevier Inc. All rights reserved.