Recurrence and Impact of Postoperative Prophylaxis in Laparoscopically Treated Primary Ileocolic Crohn Disease

Malireddy, Kishore; Larson, David W.; Sandborn, William J.; Loftus, Edward V.; Faubion, William A.; Pardi, Darrell S.; Qin, Rui; Gullerud, Rachel E.; Cima, Robert R.; Wolff, Bruce G.; Dozois, Eric J.

doi:10.1001/archsurg.2009.248

Cited by 26 publications

(11 citation statements)

References 41 publications

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“…Overall, approximately one quarter of patients experienced clinical POR, whereas more than half of patients experienced endoscopic recurrence during the first year after surgery in RCTs (Tables S1 and S2) . This rate of endoscopic POR is lower than that reported in referral centre‐based studies (Figure ).…”

Section: Rates Of Clinical and Endoscopic Recurrencementioning

confidence: 79%

Review article: the natural history of postoperative Crohn's disease recurrence

Buisson

Chevaux

Allen³

et al. 2012

Aliment Pharmacol Ther

304

192

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Summary Background Surgical resection of the diseased bowel in Crohn's disease is unfortunately not curative, and postoperative recurrence remains a problem in these patients. Aim To review the rates of and risk factors for clinical and endoscopic recurrence in population‐based studies, referral centres and randomised controlled trials. Methods We searched MEDLINE (source PUBMED, 1966 to September, 2011). Results In randomised controlled trials, clinical recurrence in the first year after surgery occurred in 10–38% of patients, whereas endoscopic recurrence in the first year was reported in 35–85% of patients. In population‐based studies, approximately half of patients experienced clinical recurrence at 10 years. In referral centres, 48–93% of the patients had endoscopic lesions (Rutgeerts’ score ≥1) in the neoterminal ileum within 1 year after surgery, whereas 20–37% had symptoms suggestive of clinical recurrence. Three years after surgery, the endoscopic postoperative recurrence rate increased to 85–100%, and symptomatic recurrence occurred in 34–86% of patients. Smoking is the strongest risk factor for postoperative recurrence, increasing by twofold, the risk of clinical recurrence. Prior intestinal resection, penetrating behaviour, perianal disease and extensive bowel disease (>50 cm) are established risk factors for postoperative recurrence. Risk factors for postoperative recurrence remain poorly defined in population‐based cohorts. Conclusion Endoscopic and clinical postoperative recurrence remains common in patients with Crohn's disease, and the identification of risk factors may allow targeted strategies to reduce this recurrence rate.

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Section: Rates Of Clinical and Endoscopic Recurrencementioning

confidence: 79%

Review article: the natural history of postoperative Crohn's disease recurrence

Buisson

Chevaux

Allen³

et al. 2012

Aliment Pharmacol Ther

304

192

View full text Add to dashboard Cite

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“…The uptake of immediate drug therapy has been variable in the past64, 201, 202 due to the limited efficacy, cost, and lack of acceptance of potential adverse drug effects in patients who have been rendered asymptomatic after resection of macroscopic disease. There have also been no long‐term data to indicate that prophylactic medications reduce the rate of reoperation or hospitalizations.…”

Section: Drug Prevention Of Disease Recurrencementioning

confidence: 99%

Postoperative recurrent luminal Crohnʼs Disease: A systematic review

Cruz

Kamm

Prideaux

et al. 2012

Inflammatory Bowel Diseases

171

134

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Despite improved immunosuppressive therapy, surgical resection is still often required for uncontrolled inflammatory disease and the stenosing and perforating complications of Crohn's disease. However, surgery is not curative. A majority of patients develop disease recurrence at or above the anastomosis. Subclinical endoscopically identifiable recurrence precedes the development of clinical symptoms; identification and treatment of early mucosal recurrence may therefore prevent clinical recurrence. Therapy to achieve mucosal healing should now be the focus of postoperative therapy. A number of clinical risk factors for the development of earlier postoperative recurrence have been identified, and reasonable evidence is now available regarding the efficacy of drug therapies in preventing recurrence. This evidence now needs to be incorporated into prospective treatment strategies.

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“…Similarly, several histological factors have been studied to identify risk factors for postoperative recurrence. However, the predictive abilities of most of the histological factors, including granulomas and pathological involvement of resection margins, remain controversial 5,[10][11][12] .…”

Section: Introductionmentioning

confidence: 99%

Predictive value of myenteric and submucosal plexitis for postoperative Crohn's disease recurrence

Nakao

Itabashi

Yamamoto

et al. 2017

J Anus Rectum Colon

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Objectives: To assess the predictive values of myenteric and submucosal plexitis for postoperative endoscopic recurrence of Crohn's disease (CD). Methods: A retrospective study of CD patients who underwent intestinal resection between 1995 and 2013 in the Department of Surgery 2, Tokyo Women's Medical University was performed. Proximal resection margins were analyzed and plexitis was evaluated by counting the number of inflammatory cells in myenteric and submucosal plexuses. The sizes of the most severely inflamed ganglion (MIG) were measured. Multiple regression analysis was used to identify independent risk factors for postoperative endoscopic recurrence. Results: Of the 51 included patients, 40 patients underwent colonoscopy after surgery. Endoscopic recurrence was observed in 21 patients (52.5%). Mean duration (±standard deviation) from surgery to recurrence was 49.7±34.7 months. Endoscopic recurrence rates at 1, 3, and 5 years were 5.0%, 24.1%, and 45.1%, respectively. Submucosal plexitis and myenteric plexitis were observed in 36 (90.0%) and 37 patients (92.5%), respectively. On multivariate analysis, initial intestinal resection, rate of plexitis <50%, size of the MIG in the myenteric plexus !867 μm 2 , and total number of inflammatory cells in the submucosal plexus !8 were independent risk factors for postoperative endoscopic recurrence. Conclusions: Pathological findings of proximal resection margins, especially submucosal plexitis and large sizes of myenteric plexus, are predictive of postoperative endoscopic recurrence in CD.

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Recurrence and Impact of Postoperative Prophylaxis in Laparoscopically Treated Primary Ileocolic Crohn Disease

Cited by 26 publications

References 41 publications

Review article: the natural history of postoperative Crohn's disease recurrence

Review article: the natural history of postoperative Crohn's disease recurrence

Postoperative recurrent luminal Crohnʼs Disease: A systematic review

Predictive value of myenteric and submucosal plexitis for postoperative Crohn's disease recurrence

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