Prognostic Value of the Modified Rutgeerts Score for Long-Term Outcomes After Primary Ileocecal Resection in Crohn's Disease

Bak, Michiel T.J.; ten Bokkel Huinink, Sebastiaan; Erler, Nicole S.; Bodelier, Alexander G.L.; Dijkstra, Gerard; Romberg-Camps, Mariëlle; de Boer, Nanne K.H.; Hoentjen, Frank; Stassen, Laurents P.S.; van der Meulen–de Jong, Andrea E.; West, Rachel L.; van Ruler, Oddeke; van der Woude, C. Janneke; de Vries, Annemarie C.; ,

doi:10.14309/ajg.0000000000002509

Cited by 4 publications

(2 citation statements)

References 26 publications

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“…The primary outcome was the long-term rate of severe endoscopic disease recurrence (defined as Rutgeerts-score i3 and i4). The definition of severe endoscopic recurrence was based on previous studies 23 , 24 and international guidelines 25 . Secondary outcomes were short-term endoscopic recurrence after 6 months as well as clinical and surgical recurrence including the need for postoperative immunosuppressive medication.…”

Section: Methodsmentioning

confidence: 99%

Positive resection margins in Crohn’s disease are a relevant risk factor for postoperative disease recurrence

Kelm,

Benatzky,

Buck

et al. 2024

Sci Rep

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Postoperative disease recurrence in Crohn’s disease represents a relevant issue despite recent advancements in surgical and medical therapies. Additional criteria are necessary to improve the identification of patients at risk and to enable selective therapeutic approaches. The role of resection margins on disease recurrence remains unclear and general recommendations are lacking. A single-center retrospective analysis was performed including all patients who received ileocecal resection due to Crohn’s disease. Resection margins were analyzed by two independent pathologists and defined by histopathological criteria based on previous consensus reports. 158 patients were included for analysis with a median follow up of 35 months. While postoperative morbidity was not affected, positive resection margins resulted in significantly increased rates of severe endoscopic recurrence at 6 months (2.0% versus 15.6%, p = 0.02) and overall (4.2% versus 19.6%, p = 0.001), which resulted in significantly increased numbers of surgical recurrence (0% versus 4.5%, p = 0.04). Additionally, positive margins were identified as independent risk factor for severe endoscopic disease recurrence in a multivariate analysis. Based on that, positive margins represent an independent risk factor for postoperative endoscopic and surgical disease recurrence. Prospective studies are required to determine whether extended resection or postoperative medical prophylaxis is beneficial for patients with positive resection margins.

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Section: Methodsmentioning

confidence: 99%

Positive resection margins in Crohn’s disease are a relevant risk factor for postoperative disease recurrence

Kelm,

Benatzky,

Buck

et al. 2024

Sci Rep

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show abstract

“…The rationale to choose for the first post-operative ileocolonoscopy is due to the known association of ePOR at first post-operative ileocolonoscopy with a higher risk on subsequent clinical and surgical recurrence. 7,14 The retrieved studies were screened and selected on the predefined in-and exclusion criteria by two independent reviewers (M.B. and K.D.).…”

Section: Study Selectionmentioning

confidence: 99%

Systematic review: Patient‐related, microbial, surgical, and histopathological risk factors for endoscopic post‐operative recurrence in patients with Crohn's disease

Bak,

Demers,

Hammoudi

et al. 2024

Aliment Pharmacol Ther

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SummaryBackgroundRisk stratification for endoscopic post‐operative recurrence (ePOR) in Crohn's disease (CD) is required to identify patients who would benefit most from initiation of prophylactic medication and intensive monitoring of recurrence.AimsTo assess the current evidence on patient‐related, microbial, surgical and histopathological risk factors for ePOR in patients with CD after ileocolic (re‐)resection.MethodsMultiple online databases (Embase, MEDLINE, Web of Science and Cochrane Library) were searched up to March 2024. Studies with reported associations of patient‐related, microbial, surgical and/or histopathological factors for ePOR (i.e., Rutgeerts’ score ≥i2 or modified Rutgeerts’ score ≥i2a) were included. The risk of bias was assessed with the Newcastle‐Ottawa Scale for observational cohort studies and case‐control studies.ResultsIn total, 47 studies were included (four RCTs, 29 cohort studies, 12 case–control studies, one cross‐sectional study and one individual participant data meta‐analysis) including 6006 patients (median sample size 87 patients [interquartile range 46–170]). Risk of bias assessment revealed a poor quality in 41% of the studies. An association was reported in multiple studies of ePOR with active smoking at and post‐surgery, male sex and prior bowel resection. A heterogeneous association with ePOR was reported for other risk factors included in the current guidelines (penetrating disease, perianal disease, younger age, extensive small bowel disease and presence of granulomas in the resection specimen or myenteric plexitis in the resection margin), and other patient‐related, microbial, surgical and histopathological factors.ConclusionRisk factors for ePOR in international guidelines are not consistently reported as risk factors in current literature except for active smoking and prior bowel resection. To develop evidence‐based, personalised strategies, large prospective studies are warranted to identify risk factors for ePOR. Validation studies of promising (bio)markers are also required.

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Interobserver agreement of current and new proposed endoscopic scores for postoperative recurrence in Crohn’s disease

Bak,

Hammoudi,

Allez

et al. 2024

Gastrointestinal Endoscopy

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Prognostic Value of the Modified Rutgeerts Score for Long-Term Outcomes After Primary Ileocecal Resection in Crohn's Disease

Cited by 4 publications

References 26 publications

Positive resection margins in Crohn’s disease are a relevant risk factor for postoperative disease recurrence

Positive resection margins in Crohn’s disease are a relevant risk factor for postoperative disease recurrence

Systematic review: Patient‐related, microbial, surgical, and histopathological risk factors for endoscopic post‐operative recurrence in patients with Crohn's disease

Interobserver agreement of current and new proposed endoscopic scores for postoperative recurrence in Crohn’s disease

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