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The Clinical Significance of Anastomotic Ulcers After Ileocolic Resection to Predict Postoperative Recurrence of Crohn’s Disease

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Abstract

Background

The Rutgeerts score is used to predict postoperative recurrence in CD patients after ileocolic resection and is primarily based on endoscopic findings at the neoterminal ileum. However, the optimal assessment of anastomotic ulcers (AUs) remains subject to debate.

Aims

We aimed to investigate the association between anastomotic ulcers (AUs) and endoscopic recurrence in postoperative Crohn’s disease (CD) patients.

Methods

This single-center retrospective study, conducted between 2000 and 2016, evaluated postoperative CD patients with endoscopic remission at the first ileocolonoscopy within 1 year after ileocolic resection and those who underwent subsequent ileocolonoscopic follow-up. The study outcome was the clinical significance of AUs in predicting endoscopic recurrence.

Results

Among 116 patients who were in endoscopic remission defined as the RS of i0 to i1 at the index postoperative ileocolonoscopy, 84.5% (98/116) underwent subsequent ileocolonoscopies. During the median 30.0 months (interquartile range, 21.3–53.3) of follow-up after the first ileocolonoscopy, 56.1% (55/98) of patients showed endoscopic recurrence. Furthermore, 65.8% (48/73) with AUs and 75.5% (40/53) with major AUs, defined as either an ulcer occupying ≥ 1/4 of the circumference, ≥ 3 ulcers confined to anastomotic ring, or any ulcers extending to the ileocolonic mucosa, showed endoscopic recurrence. On multivariable analysis, AUs (adjusted hazard ratio [aHR], 4.33; 95% confidence interval [CI], 1.87–10.0; P < 0.001) and major AUs (aHR, 3.64; 95% CI, 1.95–79; P < 0.001) were associated with endoscopic recurrence.

Conclusions

AUs are associated with a significantly high risk of endoscopic recurrence in postoperative CD patients who are in endoscopic remission.

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Acknowledgments

We thank Dr Seo Young Park for helping us to perform the statistical analyses.

Funding

No financial support was received for this work.

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Authors and Affiliations

  1. Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea

    Jin Yong Kim, Sang Hyoung Park, Jae Cheol Park, Soomin Noh, Jung Su Lee, Jeongseok Kim, Nam Seok Ham, Eun Hye Oh, Sung Wook Hwang, Dong-Hoon Yang, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung & Suk-Kyun Yang

  2. Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

    Jong Lyul Lee, Yong Sik Yoon & Chang Sik Yu

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  1. Jin Yong Kim
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Contributions

JYK and SHP conceived and designed the study, interpreted and analyzed the data, and drafted the manuscript. JYK, JCP, SN, JSL, JK, NSH, EHO, SWH, DY, BDY, JB, SM, JLL, YSY, CSY, and SY collected the data. SHP supervised the study. All authors approved the final version of the article, including the authorship list.

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Correspondence to Sang Hyoung Park.

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Kim, J.Y., Park, S.H., Park, J.C. et al. The Clinical Significance of Anastomotic Ulcers After Ileocolic Resection to Predict Postoperative Recurrence of Crohn’s Disease. Dig Dis Sci 66, 3132–3140 (2021). https://doi.org/10.1007/s10620-020-06599-3

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  • DOI: https://doi.org/10.1007/s10620-020-06599-3

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