Factors affecting the incidence of early endoscopic recurrence after ileocolonic resection for Crohn's disease: a multicentre observational study

Barcelos, Ivan Folchini de; Kotze, Paulo Gustavo; Spinelli, Antonino; Suzuki, Yasuo; Teixeira, Fábio Vieira; Albuquerque, Idblan Carvalho de; Saad-Hossne, Rogério; Kotze, Lorete Maria da Silva; Yamamoto, Takayuki

doi:10.1111/codi.13581

Cited by 31 publications

(73 citation statements)

References 26 publications

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“…According to the authors of the former study, this could be partially explained by the small number of patients recruited (n=127), including only 15% smokers. As for the latter, this result could be explained by the lack of 23% and 16% of smoking data at diagnosis and follow up respectively [ 43 , 44 ].…”

Section: Patient-related Factorsmentioning

confidence: 99%

“…It has been evaluated in several studies, but outcomes are conflicting. Searching the literature, we found studies demonstrating either male [ 49 ] or female [ 50 ] sex as a predictive factor for POR, whereas the majority of authors found no differences in recurrence rates [ 43 , 44 , 51 , 52 ].…”

Section: Patient-related Factorsmentioning

confidence: 99%

“…Younger age at diagnosis is considered to be a major factor for a more aggressive and disabling course, according to a review by Blonski et al [ 55 ]. However, the effect on POR is less clear, and data extracted from the literature do not consistently indicate age as a predictive factor [ 10 , 43 , 45 , 56 - 58 ].…”

Section: Disease-related Factorsmentioning

confidence: 99%

“…To our knowledge, only one study has shown that colonic location (Montreal-L3) is related with higher recurrence rates compared to small bowel and ileocolonic disease [ 70 ]. Finally, a number of studies have shown no correlation between disease location and POR [ 43 , 60 , 71 ]. Thus, the data from the literature remain quite conflicting, although disease of the small bowel and ileo-colon seems to increase the risk for POR.…”

Section: Disease-related Factorsmentioning

confidence: 99%

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Risk factors for postoperative recurrence of Crohn’s disease with emphasis on surgical predictors

Gklavas

Dellaportas

Papaconstantinou

2017

aog

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Intestinal resection for Crohn’s disease is not curative and postoperative recurrence rates remain high. Early detection of indices associated with recurrence and risk stratification are fundamental for the postoperative management of patients. Early endoscopy at 6-12 months is the “gold standard” procedure, whereas other modalities such as fecal calprotectin and imaging techniques can contribute to the diagnosis of recurrence. The purpose of this review is to summarize current data regarding risk factors correlated with postoperative relapse. Smoking is a well-established, modifiable risk factor. There are sufficient data that correlate penetrating disease, perianal involvement, extensive resections, prior surgery, histological features (plexitis and granulomas), and improper management after resection with high rates for recurrence. The literature provides conflicting data for other possible predictors, such as age, sex, family history of inflammatory bowel disease, location of disease, strictureplasties, blood transfusions, and postoperative complications, necessitating further evidence. On the other hand, surgical factors such as anastomotic configuration, open or laparoscopic approach, and microscopic disease at specimen margins when macroscopic disease is resected, seem not to be related with an increased risk of recurrence. Further recognition of histological features as well as gene-related factors are promising fields for research.

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Section: Patient-related Factorsmentioning

confidence: 99%

Section: Patient-related Factorsmentioning

confidence: 99%

Section: Disease-related Factorsmentioning

confidence: 99%

Section: Disease-related Factorsmentioning

confidence: 99%

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Risk factors for postoperative recurrence of Crohn’s disease with emphasis on surgical predictors

Gklavas

Dellaportas

Papaconstantinou

2017

aog

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“…This high risk of postoperative relapse and reoperation is significantly reduced if a patient quits smoking[ 4 ]. A recently published study only identified preoperative steroid use as a risk factor for early postoperative endoscopic recurrence[ 5 ], while another study found a higher risk for postoperative endoscopic recurrence in case of previous use of two or more anti-tumor necrosis factor (TNF)-α agents[ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Analysis of risk factors - especially different types of plexitis - for postoperative relapse in Crohn’s disease

Milassin¹,

Sejben²,

Tiszlavicz³

et al. 2017

WJGS

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AIMTo evaluate the presence of submucosal and myenteric plexitis and its role in predicting postoperative recurrence.METHODSData from all patients who underwent Crohn’s disease (CD)-related resection at the University of Szeged, Hungary between 2004 and 2014 were analyzed retrospectively. Demographic data, smoking habits, previous resection, treatment before and after surgery, resection margins, neural fiber hyperplasia, submucosal and myenteric plexitis were evaluated as possible predictors of postoperative recurrence. Histological samples were analyzed blinded to the postoperative outcome and the clinical history of the patient. Plexitis was evaluated based on the appearance of the most severely inflamed ganglion or nerve bundle. Patients underwent regular follow-up with colonoscopy after surgery. Postoperative recurrence was defined on the basis of endoscopic and clinical findings, and/or the need for additional surgical resection.RESULTSOne hundred and four patients were enrolled in the study. Ileocecal, colonic, and small bowel resection were performed in 73.1%, 22.1% and 4.8% of the cases, respectively. Mean disease duration at the time of surgery was 6.25 years. Twenty-six patients underwent previous CD-related surgery. Forty-three point two percent of the patients were on 5-aminosalicylate, 20% on corticosteroid, 68.3% on immunomodulant, and 4% on anti-tumor necrosis factor-alpha postoperative treatment. Postoperative recurrence occurred in 61.5% of the patients; of them 39.1% had surgical recurrence. 92.2% of the recurrences developed within the first five years after the index surgery. Mean disease duration for endoscopic relapse was 2.19 years. The severity of submucosal plexitis was a predictor of the need for second surgery (OR = 1.267, 95%CI: 1.000-1.606, P = 0.050). Female gender (OR = 2.21, 95%CI: 0.98-5.00, P = 0.056), stricturing disease behavior (OR = 3.584, 95%CI: 1.344-9.559, P = 0.011), and isolated ileal localization (OR = 2.671, 95%CI: 1.033-6.910, P = 0.043) were also predictors of postoperative recurrence. No association was revealed between postoperative recurrence and smoking status, postoperative prophylactic treatment and the presence of myenteric plexitis and relapse.CONCLUSIONThe presence of severe submucosal plexitis with lymphocytes in the proximal resection margin is more likely to result in postoperative relapse in CD.

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Perioperative optimization of Crohn's disease

Lin

Chen

et al. 2022

Annals of Gastroent Surgery

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Crohn's disease (CD) is a chronic inflammatory disease mainly affecting the gastrointestinal tract. With the increased availability of modalities in the last two decades, the treatment of CD has advanced remarkably. Although medical treatment is the mainstay of therapy, most patients require surgery during the course of their illness, especially those who experience complications. Nutritional optimization and ERAS implementation are crucial for patients with CD who require surgical intervention to reduce postoperative complications. The increased surgical risk was found to be associated with the use of corticosteroids, but the association of surgical risk with immunomodulators, biologic therapy, such as anti‐TNF mediations, anti‐integrin medications, and anti‐IL 12/23 was low in certainty. Decisions about preoperative medication must be made on an individual case‐dependent basis. Preoperative imaging studies can assist in the planning of appropriate surgical strategies and approaches. However, patients must be informed of any alterations to their treatment. In summary, the management of perioperative medications and surgery‐related decision‐making should be individualized and patient‐centered based on a multidisciplinary approach.

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Factors affecting the incidence of early endoscopic recurrence after ileocolonic resection for Crohn's disease: a multicentre observational study

Abstract: This study found that only preoperative steroid use was a significant risk factor for EPER after ileocolonic resection for CD. Prospective studies are necessary to evaluate precisely the impact of perioperative medications on EPER rates.

Cited by 31 publications

References 26 publications

Risk factors for postoperative recurrence of Crohn’s disease with emphasis on surgical predictors

Risk factors for postoperative recurrence of Crohn’s disease with emphasis on surgical predictors

Analysis of risk factors - especially different types of plexitis - for postoperative relapse in Crohn’s disease

Perioperative optimization of Crohn's disease

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