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Association Between Microscopic Lesions at Ileal Resection Margin and Recurrence After Surgery in Patients With Crohn’s Disease
- Source :
- Clinical Gastroenterology and Hepatology, Clinical Gastroenterology and Hepatology, WB Saunders, 2019, ⟨10.1016/j.cgh.2019.04.045⟩, Clinical Gastroenterology and Hepatology, 2019, ⟨10.1016/j.cgh.2019.04.045⟩
- Publication Year :
- 2019
- Publisher :
- HAL CCSD, 2019.
-
Abstract
- International audience; Background and AimsDifferent 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.MethodsWe 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.ResultsSix 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).ConclusionIn 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.
- Subjects :
- Adult
Male
medicine.medical_specialty
Cryptitis
Ileum
REMIND Trial
03 medical and health sciences
0302 clinical medicine
Crohn Disease
Recurrence
Interquartile range
medicine
Humans
Prospective Studies
Colectomy
Digestive System Surgical Procedures
Outcome
Crohn's disease
Hepatology
medicine.diagnostic_test
business.industry
Prognostic Factor
IBD Surgery
Anastomosis, Surgical
Gastroenterology
Margins of Excision
Histology
[SDV.BBM.BM]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Molecular biology
Odds ratio
Middle Aged
medicine.disease
[SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology
3. Good health
Endoscopy
Surgery
medicine.anatomical_structure
030220 oncology & carcinogenesis
Female
030211 gastroenterology & hepatology
Complication
business
Subjects
Details
- Language :
- English
- ISSN :
- 15423565
- Database :
- OpenAIRE
- Journal :
- Clinical Gastroenterology and Hepatology, Clinical Gastroenterology and Hepatology, WB Saunders, 2019, ⟨10.1016/j.cgh.2019.04.045⟩, Clinical Gastroenterology and Hepatology, 2019, ⟨10.1016/j.cgh.2019.04.045⟩
- Accession number :
- edsair.doi.dedup.....8f9b30685dece26a08f936a01452dd20