Predictive value of tissue calprotectin for disease recurrence after ileocecal resection in pediatric Crohn's disease

Crohn’s disease (CD) is a chronic inflammatory bowel disease with a relapsing, remitting course. Approximately one in four CD patients requires surgery within five years of diagnosis. Unfortunately, surgery is rarely curative and up to 70% of CD patients experience endoscopic recurrence and 40% have clinical disease recurrence within 18 months after surgery. This review is aimed at providing internists and gastroenterologists a foundation for the management of patients who underwent ileocecal resection for CD. We provide an overview of the current definitions of postoperative recurrence and prognostic factors for postoperative CD recurrence. As recent studies raised concerns about the value of these factors, we examine the evidence behind the current risk stratification algorithm and pharmacologic treatment recommendations. Lastly, we discuss future directions for research.

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Su1916 Complications and Disease Recurrence After Primary Ileocecal Resection in Pediatric Crohn's Disease: A Multicenter Cohort Analysis

Gastroenterology ◽

10.1016/s0016-5085(16)32015-7 ◽

2016 ◽

Vol 150 (4) ◽

pp. S587

Author(s):

Kay Diederen ◽

LIssy de Ridder ◽

Patrick Van Rheenen ◽

Victorien Wolters ◽

Luisa Mearin ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Cohort Analysis ◽

Disease Recurrence ◽

Ileocecal Resection ◽

Multicenter Cohort

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P457. Complications and disease recurrence after primary ileocecal resection in paediatric Crohn’s disease: a multicentre cohort analysis

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjw019.576 ◽

2016 ◽

Vol 10 (suppl 1) ◽

pp. S331-S332

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Cohort Analysis ◽

Disease Recurrence ◽

Ileocecal Resection ◽

Multicentre Cohort ◽

Paediatric Crohn’S Disease

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P171 Does microscopic involvement of the surgical margins after ileocececal resection in Crohn’s disease patients predicts early recurrence?

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.300 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S223-S223

Author(s):

M ZEMEL ◽

E Solo ◽

J Klausner ◽

H Tulchinsky

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Medical Treatment ◽

Disease Recurrence ◽

Male Gender ◽

Stapled Anastomosis ◽

Perianal Disease ◽

Ileocecal Resection ◽

Resected Specimen ◽

Histopathological Evidence

Abstract Background Past research has identified different factors which are associated with post-operative recurrence of Crohn’s disease (CD). However, controversy remained whether the microscopic presence of CD in the margins of the resected specimen increases the risk of recurrence. The main aim of our study was to determine whether microscopic presence of CD in the resected specimen margin in patients who underwent ileocecal resection predicts disease recurrence. The secondary aim was to identify other risk factors for recurrence. Methods We retrospectively evaluated all CD patients who underwent ileocecal resection in our unit between 2000 and 2015. The diagnoses of CD and information regarding the margins’ involvement were retrieved from pathology reports. Recurrence was indicated according to medical records or according to specific phone questionnaire. Demographic and clinical parameters where compared between patients with and without histopathological evidence of CD in the resected margins. Results 202 CD patients were included: 49 patients with histopathological evidence of CD in the resected margins and 153 patients without involvement. The main demographic characteristics were similar. Patients who received preoperative medical treatment had statistically significant higher rate of uninvolved margins (90.8 vs. 77.6%, p = 0.03). Technical aspects including surgical approach, conversion rates to open surgery, and anastomotic methods were similar. Likewise, the post-operative course regarding medical treatment, endoscopic and clinical recurrence, and reoperation rates was also similar. We found a statistically significant shorter time for disease recurrence in laparoscopic surgery (HR 1.6, CI 1.1–2., p = 0.02(, stapled anastomosis (HR 1.7, CI 1.2–2.6, p = 0.01), if stricturoplasty was done in addition to the ileocecal resection (HR 1.7, CI 1.1–2.6, p = 0.02(, and in patients with perianal disease (HR 1.7, CI 1.1–2.6, p = 0.02(. Male gender and conversion from laparoscopic to open surgical technique had increased HR but did not reach statistical significance. Conclusion The presence of microscopic CD at the resection margins was not associated with disease recurrence. We found that male gender, perianal disease, laparoscopic approach, conversion to laparotomy and stapled anastomosis were associated with early disease recurrence. Our results support a conservative approach in the determination of the extent of resection in CD patients having ileocecal resection.

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