Year 2021 / Volume 113 / Number 4
Original
Is the degree of i2a recurrence in Crohn’s disease secondary to ischemic phenomena?

246-250

DOI: 10.17235/reed.2020.6790/2019

Yolanda Zarauza Soto, Cristina Suárez Ferrer, Joaquín Poza Cordón, Eduardo Martín Arranz, Olivia Crivillén Anguita, José Luis Rueda García, María Sanchez Azofra, Laura García Ramírez, María Dolores Martín Arranz,

Abstract
Introduction: the Rutgeerts score is used to assess post-surgical recurrence of Crohn’s disease (CD). The score initially consisted of four grades, with a subsequent sub-classification of grade 2, under which ulcers confined to the anastomosis (i2a) are considered to be of a probable ischemic origin. The aim of this study was to assess whether ulcers confined to the anastomosis appear at the same frequency in patients undergoing surgery for other causes and can therefore be attributed to post-surgical changes. Material and methods: this was a retrospective cohort study with patients who had undergone colonoscopy as per clinical practice between 2017 and 2018. There were two cohorts, one cohort of patients to assess the post-surgical recurrence of CD and another cohort for follow-up after colorectal cancer (CRC) treated with ileocolonic anastomosis. Results: a total of 185 patients were included; 33 % had undergone surgery for CD and 67 % had undergone surgery for CRC. Fifty-six percent of patients were male. Of the patients in the group with ulcers confined to the anastomosis, 75 % had CD and 25 % had been operated on for CRC; the difference was statistically significant (p < 0.0001). In turn, of the patients operated on for CRC, 95 % had no anastomotic lesions compared to 18 % of patients with CD. These differences reached statistical significance (p < 0.0001). Conclusions: In our experience, the occurrence of ulcers on the ileocolonic anastomosis is uncommon in patients that have undergone surgery for CRC, in comparison to patients operated on due to CD. It is possible that these alterations in CD cannot therefore be attributed to solely ischemic or post-surgical phenomena.
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References
1. Frolkis AD, Dykeman J, Negron ME, et al. Risk of surgery for inflammatory bowel diseases has decreased over time: a systematic review and meta-analysis of population-based studies. Gastroenterology. 2013; 145: 996-1006.
2. Gionchetti P, Dignass A, Danese S, et al. 3rd European Evidence-based Consensus on the Diagnosis and Management of Crohn’s Disease 2016: Part 2: Surgical Management and Special Situations. J Crohns Colitis. 2017; 11: 135–149
3. Domènech E, López-Sanromán A, Nos P et al. Recomendaciones del Grupo Español de Trabajo en Enfermedad de Crohn y Colitis Ulcerosa (GETECCU) sobre la monitorización, prevención y tratamiento de la recurrencia posquirúrgica en la enfermedad de Crohn. Gastroenterol Hepatol. 2017; 40: 472-483
4. Rutgeerts P, Geboes K, Vantrappen G et al. Natural history of recurrent Crohn´s disease at the ileocolonic anastomosis after curative surgery. Gut 1984; 25: 665–672.
5. Rutgeerts P, Geboes K, Vantrappen G et al. Predictability of the Postoperative Course of Crohn’s Disease. Gastroenterology 1990; 99: 956–963.
6. Sandborn WJ, Feagan BG, Hanauer SB, et al. A review of activity índices and efficacy endpoints for clinical trials of medical therapy in adults with Crohn´s diseas. Gastroenterology 2002; 122: 512-530
7. Bemelman WA, Warusavitarne J, Sampietro GM, et al. ECCO-ESCP Consensus on Surgery for Crohn´s disease. J Cronhs Colitis 2018; 12: 1-16
8. Baudry C, Pariente B, Lourenc N et al. Tailored treatment according to early post-surgery colonoscopy reduces clinical recurrence in Crohn ’s disease: A retrospective study. Dig Liver dis Off J Ital Soc Gastroenterol Ital Assoc Study Liver 2014; 46: 887–892.
9. Olaison G, Smedh K, Sjodahl R et al. Natural course of Crohn´s disease after ileocolic resection: endoscopically visualised ileal ulcers preceeding symptoms. Gut 1992; 33: 331–335.
10. De Cruz P, Kamm MA, Hamilton AL et al. Crohn´s disease management after intestinal resection: a randomised trial. Lancet 2015; 385: 1406-1417
11. Regueiro M, Strong SA, Ferrari L, et al. Postoperative medical management of Crohns disease: prevention and surveillance strategies. J Gastrointest Surg. 2016; 20:14515-1420
12. Peyrin-Biroulet L, Deltenre P, Ardizzone S et al. Azathioprine and 6-mercaptopurine for the prevention of postoperative recurrence in Crohn´s disease: a meta-analysis. Am J Gastroenterology 2009; 104: 2089-96
13. D´Haens GR, Vermeire S, van Assche G et al. Therapy of metronidazole with azathioprine to prevent postoperative recurrence of Crohn´s disease: a controlled randomized trial. Gastroenterology 2008; 135: 1123-9
14. Osborne MJ, Hudson M, Piaseckit C et al. Crohn´s disease and anastomotic recurrence: microvascular ischaemia and anastomotic healing in an animal model. Br. J. Surg 1993; 80(2): 226–229.
15. Buisson A, Chevaux JB, Bommelaer G et al. Diagnosis, prevention and treatment of postoperative Crohn´s disease recurrence. Dig Liver dis Off J Ital Soc Gastroenterol Ital Assoc Study Liver 2012; 44: 453-460.
16. Domènech E, Mañosa M, Bernall I et al. Impact of Azathioprine on the Prevention of Postoperative Crohn ’s Disease Recurrence: Results of a Prospective, Observational, Long-term Follow-up Study. Inflamm Bowel Dis. 2008; 14: 508–513.
17. Bayart P, Duveau N, Nachury M et al. Ileal or Anastomotic Location of Lesions Does Not Impact Rate of Postoperative Recurrence in Crohn ’s Disease Patients Classified i2 on the Rutgeerts Score. Dig Dis Sci 2016; 61: 2986–2992.
18. Orlando A, Mocciaro F, Renna S, et al. Early postoperative endoscopic recurrence in Crohn´s disease patients: data from an Italian Group for the study of inflammatory bowel disease (IG-IBD) study on a large prospective multicenter cohort. J Crohns Colitis. 2014; 8: 1217-2121.
19. Riviere P, Vermeire S, Irles-Depe M, et al. No change in determining Crohn’s disease recurrence or need for endoscopic or surgical intervention with modification of Rutgeerts’ scoring system. Clin Gastroenterol Hepatol. 2019; 17: 1643-164
20. Ollech J, Aharoni-Golan M, Weisshof R, et al. Differential risk of disease progression between isolated anastomotic ulcers and mild ileal recurrence after ileocolonic resection in patients with Crohn’s disease. Gastrointest Endosc 2019; 90:269-275
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Zarauza Soto Y, Suárez Ferrer C, Poza Cordón J, Martín Arranz E, Crivillén Anguita O, Rueda García J, et all. Is the degree of i2a recurrence in Crohn’s disease secondary to ischemic phenomena?. 6790/2019


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Publication history

Received: 04/12/2019

Accepted: 19/04/2020

Online First: 19/11/2020

Published: 07/04/2021

Article revision time: 124 days

Article Online First time: 351 days

Article editing time: 490 days


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