Nassim Hammoudi1, Dominique Cazals-Hatem2, Claire Auzolle1, Charlotte Gardair3, Marjolaine Ngollo4, Hugo Bottois4, Stéphane Nancey5, Benjamin Pariente6, Anthony Buisson7, Xavier Treton8, Mathurin Fumery9, Madeleine Bezault4, Philippe Seksik10, Lionel Le Bourhis4, Jean-François Flejou11, Matthieu Allez12. 1. Université de Paris, Institut de Recherche Saint Louis, EMiLy, Inserm U1160, F-75010 Paris, France; Departement de Gastroentérologie, AP-HP, Hôpital Saint-Louis, F-75010 Paris, France. 2. Pathology Department, AP-HP, Hôpital Beaujon, Clichy, France. 3. Pathology Department, AP-HP, Hôpital Saint-Louis, Paris, France. 4. Université de Paris, Institut de Recherche Saint Louis, EMiLy, Inserm U1160, F-75010 Paris, France. 5. Gastroenterology Department, Lyon Sud Hospital, Hospices Civils de Lyon, Lyon, France. 6. Gastroenterology Department, Hôpital Claude Huriez, University of Lille 2, Lille, France. 7. Service de Médecine de l'Appareil Digestif, CHU Clermont-Ferrand, 3iHP, M2iSH, Inserm U1071, Université Clermont Auvergne, Clermont-Ferrand, France. 8. Service de Gastroentérologie, MICI et Assistance Nutritive, Hôpital Beaujon, Clichy, France. 9. Hepatogastroenterology Department, Amiens University Hospital, Amiens, France. 10. Laboratoire des Biomolécules, INSERM, CNRS, PSL Research University, Ecole normale supérieure, AP-HP, Department of Gastroenterology, Saint Antoine Hospital, Sorbonne Universités, Paris, France. 11. Pathology Department, AP-HP, Hôpital Saint-Antoine, Faculté de Médecine Sorbonne Université, Paris, France. 12. Université de Paris, Institut de Recherche Saint Louis, EMiLy, Inserm U1160, F-75010 Paris, France; Departement de Gastroentérologie, AP-HP, Hôpital Saint-Louis, F-75010 Paris, France. Electronic address: matthieu.allez@aphp.fr.
Abstract
BACKGROUND AND AIMS: Different 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. METHODS: We 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. RESULTS: Six 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). CONCLUSION: In 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.
BACKGROUND AND AIMS: Different 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. METHODS: We 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. RESULTS: Six 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). CONCLUSION: In 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.
Authors: Gian Paolo Caviglia; Chiara Angela Mineo; Chiara Rosso; Angelo Armandi; Marco Astegiano; Gabriella Canavese; Andrea Resegotti; Giorgio Maria Saracco; Davide Giuseppe Ribaldone Journal: J Clin Med Date: 2022-08-27 Impact factor: 4.964