The Clinical Significance of Anastomotic Ulcers After Ileocolic Resection to Predict Postoperative Recurrence of Crohn's Disease.
The Clinical Significance of Anastomotic Ulcers After Ileocolic Resection to Predict Postoperative Recurrence of Crohn's Disease.
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DOI：
10.1007/s10620-020-06599-3
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发表时间：
2021-09-01
影响因子：
3.1
通讯作者：
Yang, Suk-Kyun
中科院分区：
文献类型：
--
作者：
Kim, Jin Yong;Park, Sang Hyoung;Yang, Suk-Kyun
背景：Rutgeerts评分用于预测回结肠切除术后CD患者的术后复发，主要基于内镜下新末端回肠的发现。然而，对吻合口溃疡（AUs）的最佳评估仍然存在争议。目的：我们旨在研究克罗恩病（CD）术后吻合口溃疡（AUs）与内镜下复发的关系。方法：这项在2000年至2016年间进行的单中心回顾性研究，评估了回肠切除术后1年内首次回肠结肠镜检查缓解的CD患者以及随后接受回肠结肠镜随访的患者。研究结果为AUs预测内镜下复发的临床意义。结果：116例内镜缓解患者（术后回肠结肠镜检查指数RS为0 ~ 11）中，84.5%（98/116）的患者接受了后续回肠结肠镜检查。首次回肠结肠镜检查后随访中位30个月（四分位间距21.3 ~ 53.3），56.1%（55/98）患者出现内镜下复发。此外，65.8%（48/73）的AUs和75.5%（40/53）的重度AUs（定义为溃疡占据≥1/4周长，≥3个溃疡局限于吻合环，或任何溃疡延伸到回肠结肠粘膜）在内镜下复发。在多变量分析中，AUs(校正风险比[aHR]， 4.33； 95%可信区间[CI]， 1.87-10.0
BACKGROUND: The Rutgeerts score is used to predict postoperative recurrence in CD patients after ileocolic resection and is primarily based on endoscopic findings at the neoterminal ileum. However, the optimal assessment of anastomotic ulcers (AUs) remains subject to debate.AIMS: We aimed to investigate the association between anastomotic ulcers (AUs) and endoscopic recurrence in postoperative Crohn's disease (CD) patients.METHODS: This single-center retrospective study, conducted between 2000 and 2016, evaluated postoperative CD patients with endoscopic remission at the first ileocolonoscopy within 1year after ileocolic resection and those who underwent subsequent ileocolonoscopic follow-up. The study outcome was the clinical significance of AUs in predicting endoscopic recurrence.RESULTS: Among 116 patients who were in endoscopic remission defined as the RS of i0 to i1 at the index postoperative ileocolonoscopy, 84.5% (98/116) underwent subsequent ileocolonoscopies. During the median 30.0months (interquartile range, 21.3-53.3) of follow-up after the first ileocolonoscopy, 56.1% (55/98) of patients showed endoscopic recurrence. Furthermore, 65.8% (48/73) with AUs and 75.5% (40/53) with major AUs, defined as either an ulcer occupying≥1/4 of the circumference,≥3 ulcers confined to anastomotic ring, or any ulcers extending to the ileocolonic mucosa, showed endoscopic recurrence. On multivariable analysis, AUs (adjusted hazard ratio [aHR], 4.33; 95% confidence interval [CI], 1.87-10.0; P