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Ileocolonic End-to-End Anastomoses in Crohn’s Disease Increase the Risk of Early Post-operative Endoscopic Recurrence in Those Undergoing an Emergency Resection

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background and Aim

Several risk factors affecting post-operative recurrence in Crohn’s disease patients have been studied, and of these, the role of the anastomosis remains contentious. We aimed to compare the risk of developing early post-operative endoscopic recurrence (EPER), in resections that had an end-to-end anastomosis (ETEA) to a side-to-side anastomosis (STSA).

Methods

All Crohn’s disease patients that underwent an ileocolic or small bowel resection between January 2012 and June 2017 at two tertiary IBD centres were reviewed retrospectively. Included patients had a minimum of 12-month clinical follow-up and a colonoscopy within 12 months of the resection or stoma reversal. Univariate and multivariate binary logistic regression analyses determined the independent risk factors for early post-operative endoscopic recurrence, defined as a Rutgeerts score of ≥ i2b.

Results

Ninety-two resections associated with an ETEA or a STSA were included for analysis. The ETEA was the most common anastomosis, constructed in 55 patients (59.8%). Forty-nine operations (53.3%) resulted in a ≥ i2b recurrence at the first surveillance colonoscopy. The multivariate analysis showed that there was no difference between the ETEA and STSA in determining the odds ratio (OR) for developing EPER (OR = 2.41 (0.95–6.05), P = 0.06). In those that underwent a resection emergently however, the significant determinants of EPER were as follows: having an ETEA (OR = 38.12 (2.44–595.87), P = 0.01), failing to commence a biologic and/or an immunosuppressant early (OR = 24.21 (1.69, 347.81), P = 0.02), and active smoking (OR = 7.19 (1.12–46.21), P = 0.04).

Conclusion

The ETEA is best avoided in those undergoing an emergency resection. The early commencement of a biologic and/or an immunosuppressant and smoking cessation is imperative this high-risk group of patients.

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Authors and Affiliations

  1. Department of Gastroenterology, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, Perth, Western Australia, 6150, Australia

    Lena W. Y. Thin & Shanela Sooben

  2. Level 1, Harry Perkins Institute of Medical Research, 11 Robin Warren Drive, Murdoch, Perth, Western Australia, 6510, Australia

    Lena W. Y. Thin

  3. School of Medicine and Pharmacology, University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6150, Australia

    Lena W. Y. Thin & Marina H. Wallace

  4. Department of Gastroenterology, Royal Perth Hospital, 197 Wellington St, Perth, WA, 6000, Australia

    Sherman Picardo

  5. School of Population Health, University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6000, Australia

    Kevin Murray

  6. Department of Colorectal Surgery, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, Perth, Western Australia, 6150, Australia

    Jennifer Ryan & Marina H. Wallace

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  1. Lena W. Y. Thin
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Correspondence to Lena W. Y. Thin.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was reviewed and approved by the institution’s ethics committee. For this type of study formal consent was not required.

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Thin, L.W.Y., Picardo, S., Sooben, S. et al. Ileocolonic End-to-End Anastomoses in Crohn’s Disease Increase the Risk of Early Post-operative Endoscopic Recurrence in Those Undergoing an Emergency Resection. J Gastrointest Surg 25, 241–251 (2021). https://doi.org/10.1007/s11605-020-04578-7

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