Postoperative Endoscopic Recurrence on the Neoterminal Ileum But Not on the Anastomosis Is Mainly Driving Long-Term Outcomes in Crohn's Disease
Postoperative Endoscopic Recurrence on the Neoterminal Ileum But Not on the Anastomosis Is Mainly Driving Long-Term Outcomes in Crohn's Disease
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DOI：
10.14309/ajg.0000000000000638
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发表时间：
2020-07-01
影响因子：
9.8
通讯作者：
Allez, Matthieu
中科院分区：
文献类型：
--
作者：
Hammoudi, Nassim;Auzolle, Claire;Allez, Matthieu
摘要：术后一年内早期回肠结肠镜检查是评估克罗恩病（CD）回肠结肠镜切除后复发的金标准。该研究的目的是评估术后早期回肠结肠镜检查中吻合口和回肠病变的存在和严重程度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。包括因回肠或回肠结肠CD手术的患者。术后6个月行回肠结肠镜检查。内镜评分分别描述吻合口和回肠病变。临床复发由cd相关症状定义，并通过影像学、内窥镜检查或强化治疗证实；CD-related并发症;或者后续的手术。结果：纳入的225例患者中，有193例进行了长期随访（中位随访：3.82年[四分位数间距：2.56-5.41]）。中位临床无复发生存期为47.6个月。术后早期内镜检查回肠病变患者的临床无复发生存期(I（1)或I(2,3,4)）明显短于无回肠病变患者（I(0)） (I(0) vs I(2,3,4): P= 0.0003；我(0)与(1):P = 0.0008我(1)和(2、3、4):P = 0.43)。单纯回肠病变(A（0)I(1,2,3,4)）患者的临床远期预后较单纯吻合口病变(A（1,2,3)I(0)）患者差（P= 0.009）。讨论：分别描述吻合口和回肠病变的评分可能更适合定义术后内镜下复发。我们的数据表明，患有回肠病变的患者，包括轻度的患者（I(1)），可以从治疗升级中受益，以改善长期预后。
INTRODUCTION: Early ileocolonoscopy within the first year after surgery is the gold standard to evaluate recurrence after ileocolonic resection for Crohn's disease (CD). The aim of the study was to evaluate the association between the presence and severity of anastomotic and ileal lesions at early postoperative ileocolonoscopy and long-term outcomes.METHODS: The REMIND group conducted a prospective multicenter study. Patients operated for ileal or ileocolonic CD were included. An ileocolonoscopy was performed 6 months after surgery. An endoscopic score describing separately the anastomotic and ileal lesions was built. Clinical relapse was defined by the CD-related symptoms, confirmed by imaging, endoscopy or therapeutic intensification; CD-related complications; or subsequent surgery.RESULTS: Among 225 included patients, long-term follow-up was available in 193 (median follow-up: 3.82 years [interquartile range: 2.56-5.41]). Median clinical recurrence-free survival was 47.6 months. Clinical recurrence-free survival was significantly shorter in patients with ileal lesions at early postoperative endoscopy whatever their severity was (I(1) or I(2,3,4)) as compared to patients without ileal lesions (I(0)) (I(0) vs I(2,3,4): P= 0.0003; I(0) vs I(1): P= 0.0008 and I(1) vs I(2,3,4): P= 0.43). Patients with exclusively ileal lesions (A(0)I(1,2,3,4)) had poorer clinical long-term outcomes than patients with exclusively anastomotic lesions (A(1,2,3)I(0)) (P= 0.009).DISCUSSION: A score describing separately the anastomotic and ileal lesions might be more appropriate to define postoperative endoscopic recurrence. Our data suggest that patients with ileal lesions, including mild ones (I(1)), could beneficiate from treatment step-up to improve long-term outcomes.