Thread by @IbdClub

Presenting this month #MarchMadness our own @anamomerMD on outcomes of postoperative endoscopic recurrence in Crohn disease published recently in @AmJGastro of @AmCollegeGastro
Watch video abstract 📽️👇

Introduction: Early ileocolonoscopy within the first year after surgery is the gold standard to evaluate recurrence after ileocolonic resection for Crohn's disease (CD)

The aim of the study was to evaluate the association between the presence and severity of anastomotic and ileal lesions at early postoperative ileocolonoscopy and long-term outcomes

Method: The REMIND group ( France) conducted a prospective multicenter study. Patients operated for ileal or ileocolonic CD were included. An ileocolonoscopy was performed 6 months after surgery

Method: An endoscopic score describing separately the anastomotic and ileal lesions was built. Clinical relapse was defined by the CD-related symptoms, confirmed by imaging, endoscopy or therapeutic intensification; CD-related complications; or subsequent surgery

Results: Median clinical recurrence-free survival was 47.6 months. Clinical recurrence-free survival was significantly shorter in patients with ileal lesions at early postoperative endoscopy whatever their severity was (I(1) or I(2,3,4))

Results: Patients with exclusively ileal lesions (A(0)I(1,2,3,4)) had poorer clinical long-term outcomes than patients with exclusively anastomotic lesions (A(1,2,3)I(0)) (P = 0.009).

Results: Severe anastomotic lesions (more than semi circumferential ulcers here graded A(2) or A(3)) were associated with significantly more occlusive complications and a trend toward a higher clinical recurrence

Conclusion: A score describing separately the anastomotic and ileal lesions might be more appropriate to define postoperative endoscopic recurrence.

Conclusion: The data suggest that patients with ileal lesions, including mild ones (I(1)), could beneficiate from treatment step-up to improve long-term outcomes.

Limitations: The major limitation of our study is the absence of endoscopic central reading, which could have led to misclassifications of the endoscopic lesions.

These results suggest that mild lesions (I(1)) should be taken into account for treatment escalation or optimization. The REMIND score proposed here, describing separately anastomotic and ileal lesions, might be more appropriate to predict the postoperative outcomes.

Reference:
pubmed.ncbi.nlm.nih.gov/32618659/

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