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Association Between Microscopic Lesions at Ileal Resection Margin and Recurrence After Surgery in Patients With Crohn’s Disease

2019; Elsevier BV; Volume: 18; Issue: 1 Linguagem: Inglês

10.1016/j.cgh.2019.04.045

1542-7714

Nassim Hammoudi, Dominique Cazals–Hatem, Claire Auzolle, Charlotte Gardair, Marjolaine Ngollo, Hugo Bottois, Stéphane Nancey, Benjamin Pariente, Anthony Buisson, Xavier Tréton, Mathurin Fuméry, Madeleine Bezault, Philippe Seksik, Lionel Le Bourhis, Jean-François Fléjou, Matthieu Allez, Pierre Cattan, Mircea Chirica, Nicolas Munoz‐Bongrand, Hélène Corte, Nathan Beaupel, J. Catry, Jean‐Marc Gornet, Clotilde Baudry, Nelson Lourenço, Mariane Maillet, My‐Linh Tran‐Minh, Victor Chardiny, C Grand, Brice Gergaud, Joëlle Bonnet, Leïla Chedouba, A Nisard, Laurent Beaugerie, Harry Sokol, Anne Bourrier, Isabelle Nion–Larmurier, Julien Kirchgesner, Elodie Quévrain, Loïc Brot, Najim Chafaı̈, Jéremie H. Lefèvre, Emmanuel Tiret, Magali Svrcek, Nathalie Guedj, Yves Panís, Leon Magiorri, Marianne Ferron, Yoram Bouhnik, Olivier Corcos, Carmen Stefănescu, Philippe Marteau, Xavier Dray, Ulrika Chaput, Rachid Kaci, Anne Dubois, Gilles Bommelaer, Marion Goutte, Nicolas Barnich, Dilek Çoban, Catherine Godfraind, Juliette Joubert Zakeyh, Pierre Desreumaux, Maria Nachury, Coralie Sommeville, Florence Renaud, Jean‐Louis Dupas, Julien Loreau, Franck Brazier, Denis Chatelain, Christophe Attencourt, Charles Sabbagh, Martine Leconte, Gilles Boschetti, Bernard Flourié, Yves François, Eddy Cotte, Anne-Laure Charlois, Peggy Falgon, Helena Hadjisavvas, Driffa Moussata, Marion Chauvenet, Sarah Boyer, Alexandra Traverse‐Glehen, Xavier Hébuterne, Jérôme Filippi, Paul Hofmann, Amine Rahili, Stéphanie Patouraux, Xavier Jouven,

Diverticular Disease and Complications

Different types of histologic lesions at the ileal margin, detected by histology, have been associated with increased rates of recurrence after ileocaecal surgery in patients with Crohn's disease (CD). We aimed to characterize histologic features of the ileal margin and to evaluate their association with disease recurrence.We collected histologic data from 211 patients with ileal or ileocolonic CD who underwent ileocolonic resections at hospitals in France from September 2010 through December 2016. Ileal margins were analyzed. Early endoscopic recurrence was defined by a Rutgeerts score of i2 or more, 6 months after surgery. We also collected data from 10 adults with healthy ileum who underwent ileocecal resection for colonic tumors (controls). Clinical relapse was defined by CD-related symptoms confirmed by imaging, endoscopy, therapy intensification, CD-related complication, or subsequent surgery.Six months after surgery, 49% of patients had endoscopic recurrence; 5 years after surgery, 57% of patients had clinical relapse. Ileal margins were macroscopically affected in 20.9% of patients. CD transmural lesions at the margin (defined by mucosal ulceration or cryptitis, submucosal fibrosis and lymphoplasmacytic infiltrate of the subserosa) were observed in 13.6% of patients. Endoscopic recurrence was observed in 75% of patients with CD transmural lesions vs 46% of patients without (P =.005). In multivariate analysis, CD transmural lesions at the margin were independently associated with early endoscopic recurrence (OR, 3.83; 95% CI, 1.47-11.05; P =.008) and clinical recurrence (OR 2.04; 95% CI, 1.09-3.99; P =.026).In patients with CD, transmural lesions at the ileal margin were associated with an increased risk of post-operative recurrence. Histologic features of the ileal margin should be included in making decisions about post-operative therapy.