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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.
Author(s)
김정석김진용노수민명승재박상형박재철변정식양동훈양석균예병덕오은혜유창식윤용식이정수이종률함남석황성욱
Issued Date
2021
Type
Article
Keyword
Abridged Index MedicusBiochemistryDiseasesEndoscopyGastroenterologygeneralHepatologyMedical collegesMedical researchMedicineMedicine &amp; Public HealthMedicineExperimentalOncologyOriginal ArticlePrognosisRelapseRemission (Medicine)SurgeryTransplant SurgeryUlcers
DOI
10.1007/s10620-020-06599-3
URI
https://oak.ulsan.ac.kr/handle/2021.oak/8084
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_proquest_miscellaneous_2442842976&amp;context=PC&amp;vid=ULSAN&amp;lang=ko_KR&amp;search_scope=default_scope&amp;adaptor=primo_central_multiple_fe&amp;tab=default_tab&amp;query=any,contains,The%20Clinical%20Significance%20of%20Anastomotic%20Ulcers%20After%20Ileocolic%20Resection%20to%20Predict%20Postoperative%20Recurrence%20of%20Crohn%E2%80%99s%20Disease&amp;offset=0&amp;pcAvailability=true
Publisher
DIGESTIVE DISEASES AND SCIENCES
Location
미국
Language
영어
ISSN
0163-2116
Citation Volume
66
Citation Number
9
Citation Start Page
3132
Citation End Page
3140
Appears in Collections:
Medicine > Medicine
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