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Certain Lesions at Resection Linked to Crohn's Recurrence
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Histologic features at the ileal margin were associated with an increased risk for post-operative recurrence of Crohn’s disease, according to study results.
Matthieu Allez, MD, PhD, of the department of gastroenterology at Hôpital Saint-Louis in France, and colleagues wrote that mixed results in previous studies have left the impact of lesions at the proximal ileal margin on recurrence unclear. The aim of their study was to assess histologic features of the ileal margin.
“Several risk factors have been reported to increase post-operative recurrence, including active smoking, penetrating disease, history of perianal disease, previous intestinal surgery and male gender,” they wrote. “There is still a need for factors that can accurately risk-stratify patients.”
Researchers collected histologic data from 211 patients with ileal or ileocolonic CD who underwent ileocolonic resections from 2010 to 2016, as well as from 10 patients with a healthy ileum who underwent ileocecal resection for colonic tumors (controls). They analyzed ileal margins to assess endoscopic recurrence (defined by a Rutgeerts score of i2 or more, 6 months after surgery) and clinic relapse, defined by CD-related symptoms confirmed by imaging, endoscopy, therapy intensification, CD-related complication or subsequent surgery.
Within 6 months following surgery, 49% of patients had endoscopic recurrence, while 57% of patients were in clinical relapse within 5 years. Approximately one-fifth of patients had macroscopically affected ileal margins, while 13.6% had CD transmural lesions at the margin, defined by mucosal ulceration or cryptitis, submucosal fibrosis and lymphoplasmocytic infiltrate of the subserosa.
Investigators found that in patients with CD transmural lesions, 75% had endoscopic recurrence compared with 46% of patients without (P = .005). In their analysis, researchers determined that those lesions at the margin were independently associated with early endoscopic recurrence (OR = 3.83; 95% CI, 1.47–11.05) and clinical response (OR = 2.04; 95% CI, 1.09–3.99).
Allez and colleagues wrote that pathologists need to detail the presence of these specific lesions in the ileal margin of resection to help guide treatment after surgery.
“A systematic post-operative treatment could be proposed to patients with transmural histological lesions, even in absence of other risk factors,” they concluded. “The better post-operative treatment to initiate to these patients remains to be determined.” – by Alex Young
Disclosures: Allez reports receiving honoraria from AbbVie, Celegene, Ferring, Genentech/Roche, Janssen, MSD, Novartis, Pfizer, Takeda and Tillots. Please see the full study for all other authors’ relevant financial disclosures.
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