Imelda GI Clinical Research Centre, Imeldaziekenhuis Bonheiden, Bonheiden, Belgium; Department of Hepato-Gastroenterology, Nancy University Hospital, Vandoeuvre-lès-Nancy, France.
Unit of Methodology, Data-management and Statistic (UMDS), Nancy University Hospital, Vandoeuvre-lès-Nancy, France.
Clin Gastroenterol Hepatol. 2021 Jun;19(6):1218-1225.e4. doi: 10.1016/j.cgh.2020.05.027. Epub 2020 May 20.
BACKGROUND & AIMS: The risk of recurrence of Crohn's disease (CD) from 1 to 10 years after surgery despite initial endoscopic remission (late post-operative recurrence) is not clear.
We performed a retrospective study, at 3 inflammatory bowel disease (IBD) centers in France and Belgium, of all patients with CD (n = 86) undergoing an ileocecal resection with curative intent from 2006 through 2016 who did not have endoscopic evidence for recurrence (Rutgeerts score less than i2) at their baseline assessment. Postoperative recurrence after baseline endoscopy was defined as a composite endpoint of at least 1 of the following: clinical recurrence, IBD-related hospitalization, occurrence of bowel damage, need for endoscopic balloon dilatation of the anastomosis, and need to repeat the surgery. Risk of mucosal disease progression was studied as a secondary outcome.
The median time between surgery and baseline endoscopy was 7 months (IQR, 5.7-9.5 months); 40 patients (46.5%) received medical prophylaxis in this period. The median follow-up time was 3.5 years (IQR, 1.6-5.3 years). Thirty-five patients (40.7%) had a late post-operative recurrence of CD, with a median time to disease recurrence after baseline endoscopy of 14.2 months (IQR, 6.3-26.1 months). Recurrence status did not differ significantly between patients with Rutgeerts scores of i0 (20/55) or i1 (15/31) at baseline (P = .28) and was independent of medical prophylaxis (16/40 with prophylactic therapy vs 19/46 without prophylactic therapy; P = .90). Mucosal disease progressed in 29 of the 71 patients (40.8%) with available data. We did not identify risk factors for late post-operative recurrence of CD or mucosal disease progression.
Among patients with CD treated by ileocecal resection, 40% of patients had a late recurrence, despite initial endoscopic remission, after a median follow-up time of 3.5 years. Tight monitoring of these patients is recommended beyond 18 months.
尽管术后最初内镜缓解（晚期术后复发），但在手术后 1 至 10 年内克罗恩病（CD）复发的风险尚不清楚。
我们在法国和比利时的 3 个炎症性肠病（IBD）中心进行了一项回顾性研究，纳入 2006 年至 2016 年期间接受以治愈为目的的回肠末端和回盲部切除术且基线评估时无内镜下复发证据（Rutgeerts 评分＜i2）的 86 例 CD 患者。基线内镜检查后出现的术后复发定义为以下至少 1 种情况的复合终点：临床复发、与 IBD 相关的住院治疗、肠道损伤发生、需要进行吻合口内镜球囊扩张以及需要再次手术。将黏膜疾病进展的风险作为次要结局进行研究。
手术与基线内镜检查之间的中位时间为 7 个月（IQR，5.7-9.5 个月）；在此期间，40 例患者（46.5%）接受了药物预防。中位随访时间为 3.5 年（IQR，1.6-5.3 年）。35 例患者（40.7%）出现 CD 的晚期术后复发，基线内镜检查后疾病复发的中位时间为 14.2 个月（IQR，6.3-26.1 个月）。基线时 Rutgeerts 评分为 i0（20/55）或 i1（15/31）的患者之间复发情况无显著差异（P=0.28），且与药物预防无关（接受预防治疗的 40 例患者中有 16 例与未接受预防治疗的 46 例患者中有 19 例；P=0.90）。在可获得数据的 71 例患者中，29 例（40.8%）黏膜疾病进展。我们未发现 CD 晚期术后复发或黏膜疾病进展的危险因素。
在接受回肠末端和回盲部切除术治疗的 CD 患者中，尽管术后最初内镜缓解，但在中位随访 3.5 年后仍有 40%的患者出现晚期复发。建议对这些患者进行 18 个月以上的密切监测。
