Claire Auzolle1,2, Stephane Nancey3, My-Linh Tran-Minh1, Anthony Buisson4, Benjamin Pariente5, Carmen Stefanescu6, Mathurin Fumery7, Philippe Marteau8, Xavier Treton6, Nassim Hammoudi1, Xavier Jouven2, Philippe Seksik8, Matthieu Allez1. 1. Department of Gastroenterology, Hôpital Saint-Louis, APHP, INSERM U1160, University Denis Diderot, Paris, France. 2. PARCC, Paris, France. 3. Department of Gastroenterology, Lyon Sud Hospital, Hospices Civils de Lyon, Lyon, France. 4. Université Clermont Auvergne, Inserm U1071, M2iSH, 3iHP, CHU Clermont-Ferrand, Service de Médecine de l'Appareil Digestif Clermont-Ferrand, Clermont-Ferrand, France. 5. Department of Gastroenterology, Claude Huriez Hospital, University of Lille 2, Lille, France. 6. Hôpital Beaujon, Service de Gastroentérologie, MICI et Assistance Nutritive, Clichy, France. 7. Department of Hepatogastroenterology, Amiens University Hospital, Amiens, France. 8. Gastroenterology, Sorbonne Universités, AP-HP, Hospital Saint-Antoine, Paris, France.
Abstract
BACKGROUND: After ileocaecal resection for Crohn's disease (CD), inflammatory lesions frequently recur on the anastomosis and/or on the neo-terminal ileum. AIM: To identify predictors of early post-operative endoscopic recurrence. METHODS: From September 2010 to September 2017, the REMIND group conducted a prospective nationwide study in nine French academic centres. Data were collected at the time of surgery and endoscopy, performed 6-12 months after surgery. Endoscopic recurrence was defined as a Rutgeerts score ≥i2. Baseline factors associated with endoscopic recurrence were searched by univariate and multivariate regression analysis. RESULTS: Two hundred and eighty-nine CD patients were included. Endoscopy within 1 year following surgery was performed in 225 (78%) patients (104M/121F). Mean age and disease duration were 35 (12.2) and 8.8 (8.9) years respectively. Seventy (32%) patients were active smokers at surgery. One hundred and forty-two (63%) patients received at least one anti-TNF therapy before surgery. After surgery, 40 (18%) patients received thiopurines and 66 (29%) received an anti-TNF agent. Endoscopic recurrence occurred in 107 (47%) patients. In multivariate analysis, male gender (OR = 2.48 [IC 95% 1.40-4.46]), active smoking at surgery (OR = 2.65 [IC 95% 1.44-4.97]) and previous resection (OR = 3.03 [IC 95% 1.36-7.12]) were associated with a higher risk of endoscopic recurrence. Inversely, post-operative anti-TNF treatment decreased the risk of endoscopic recurrence (OR = 0.50 [IC 95% 0.25-0.96]). CONCLUSIONS: Male gender, active smoking at surgery and previous intestinal resection are associated with a higher risk of endoscopic post-operative recurrence, while post-operative anti-TNF treatment is associated with a lower risk.
BACKGROUND: After ileocaecal resection for Crohn's disease (CD), inflammatory lesions frequently recur on the anastomosis and/or on the neo-terminal ileum. AIM: To identify predictors of early post-operative endoscopic recurrence. METHODS: From September 2010 to September 2017, the REMIND group conducted a prospective nationwide study in nine French academic centres. Data were collected at the time of surgery and endoscopy, performed 6-12 months after surgery. Endoscopic recurrence was defined as a Rutgeerts score ≥i2. Baseline factors associated with endoscopic recurrence were searched by univariate and multivariate regression analysis. RESULTS: Two hundred and eighty-nine CDpatients were included. Endoscopy within 1 year following surgery was performed in 225 (78%) patients (104M/121F). Mean age and disease duration were 35 (12.2) and 8.8 (8.9) years respectively. Seventy (32%) patients were active smokers at surgery. One hundred and forty-two (63%) patients received at least one anti-TNF therapy before surgery. After surgery, 40 (18%) patients received thiopurines and 66 (29%) received an anti-TNF agent. Endoscopic recurrence occurred in 107 (47%) patients. In multivariate analysis, male gender (OR = 2.48 [IC 95% 1.40-4.46]), active smoking at surgery (OR = 2.65 [IC 95% 1.44-4.97]) and previous resection (OR = 3.03 [IC 95% 1.36-7.12]) were associated with a higher risk of endoscopic recurrence. Inversely, post-operative anti-TNF treatment decreased the risk of endoscopic recurrence (OR = 0.50 [IC 95% 0.25-0.96]). CONCLUSIONS: Male gender, active smoking at surgery and previous intestinal resection are associated with a higher risk of endoscopic post-operative recurrence, while post-operative anti-TNF treatment is associated with a lower risk.
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