Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Illinois, USA.
Section of Gastroenterology, Department of Internal Medicine, Toho University Sakura Medical Center, Chiba, Japan.
J Gastroenterol Hepatol. 2021 Oct;36(10):2785-2793. doi: 10.1111/jgh.15540. Epub 2021 May 19.
Approximately half of patients with Crohn's disease (CD) who have surgery will experience clinical recurrence within 10 years of their surgery. This study aimed to assess the postoperative outcomes according to disease location and validated the simple endoscopic score for CD (SES-CD) to predict disease-related outcomes.
We retrospectively assessed medical records of CD patients who underwent ileocolonoscopy within 12 months after surgery at the University of Chicago between 2005 and 2016. We defined patients with postoperative colonic inflammation at the first postoperative ileocolonoscopy or had Montreal classification L2 as colon-dominant disease and patients without colonic involvement or who had L1 as small intestine (SI)-dominant disease. The outcomes included clinical and surgical recurrence.
Among 207 CD patients, 51 (24.6%) and 156 (75.4%) patients had colon-dominant and SI-dominant disease, respectively. Patients with colon-dominant disease had a greater risk of postoperative clinical recurrence compared with those with SI-dominant disease (P = 0.018). Colon-dominant disease was a risk of earlier surgical recurrence compared with SI-dominant disease, although there were no significant differences in the recurrence-free survivals. SES-CD > 2 at the first postoperative ileocolonoscopy was a significant risk of clinical recurrence on log-rank test (P < 0.001) and Cox proportional hazards model (hazard ratio = 2.25; 95% confidence interval = 1.14-4.47; P = 0.020). An SES-CD of 1 was an appropriate cut-off to predict the clinical recurrence of SI-dominant disease, but a higher SES-CD cut-off value of 5 was required for colon-dominant disease.
We demonstrated that SES-CD predicts postoperative clinical recurrence of CD, regardless of disease location.
约有一半的克罗恩病（CD）患者在手术后 10 年内会出现临床复发。本研究旨在评估根据疾病部位的手术治疗后结局，并验证简单的 CD 内镜评分（SES-CD）对预测疾病相关结局的有效性。
我们回顾性评估了 2005 年至 2016 年期间在芝加哥大学接受手术后 12 个月内进行的回结肠镜检查的 CD 患者的病历。我们将术后首次回结肠镜检查时存在结肠炎症或存在蒙特利尔分类 L2 的患者定义为结肠为主疾病，而无结肠受累或存在 L1 的患者则定义为小肠（SI）为主疾病。结局包括临床和手术复发。
在 207 例 CD 患者中，51 例（24.6%）和 156 例（75.4%）患者分别存在结肠为主和 SI 为主疾病。与 SI 为主疾病相比，结肠为主疾病患者的术后临床复发风险更高（P=0.018）。尽管在无复发生存率方面无显著差异，但结肠为主疾病是手术复发的危险因素。首次术后回结肠镜检查时 SES-CD>2 是临床复发的显著危险因素（对数秩检验 P<0.001；Cox 比例风险模型，风险比=2.25；95%置信区间 1.14-4.47；P=0.020）。SES-CD=1 是预测 SI 为主疾病临床复发的适当临界值，但结肠为主疾病需要更高的 SES-CD 临界值（5）。
我们证明 SES-CD 可预测 CD 的术后临床复发，与疾病部位无关。
