TY - JOUR
T1 - Endoscopic Recurrence or Anastomotic Wound Healing Phenomenon after Ileocolic Resection for Crohn's Disease
T2 - The Challenges of Accurate Endoscopic Scoring
AU - van der Does de Willebois, Eline M. L.
AU - Duijvestein, Marjolijn
AU - Wasmann, Karin A.
AU - D'Haens, Geert R. A. M.
AU - van der Bilt, Jarmila D. W.
AU - Mundt, Marco W.
AU - Hompes, Roel
AU - van der Vlugt, Manon
AU - Buskens, Christianne J.
AU - Bemelman, Willem A.
N1 - Funding Information: The DETECT study was financially supported by grants from the BROAD Medical Research Program–Crohn’s and Colitis Foundation and the International Organization for Inflammatory Bowel Diseases. Vitamin D and placebo vials were kindly provided by SMB Pharma. SMB Pharma, BROAD Medical Research Program–Crohn’s and Colitis Foundation, and the International Organization for Inflammatory Bowel Diseases were not involved in data collection or analysis. We thank Mariska van Bergman and Paulien van Wetenschap of Bergman clinics, Amsterdam, the Netherlands; and Renske Bovenhuis-Haveman and Bertine van Voorthuizen of Flevoziekenhuis, Almere, the Netherlands for patient inclusion of the CRC cohort. DETECT steering committee: Peter Bossuyt, Marc Ferrante, Marjolijn Duijvestein, Rachel West, Ben Witteman, Gerard Dijkstra, Jessica de Bruyn, Geert D’Haens. All collaborators of the DETECT study [The Effect of Vitamin D3 to Prevent Postoperative Relapse of Crohn’s Disease: a Placebo-controlled Randomized Trial] are listed in the Supplementary Appendix. Publisher Copyright: © The Author(s) 2022. Published by Oxford University Press on behalf of European Crohn’s and Colitis Organisation.
PY - 2023/5/1
Y1 - 2023/5/1
N2 - BACKGROUND AND AIMS: Adequate endoscopic scoring in Crohn's disease [CD] is crucial, as it dictates the need for initiating postoperative medical therapy and is utilized as an outcome parameter in clinical trials. Here we aimed to observe anastomotic wound healing in relation to endoscopic scoring of both inverted and everted stapled lines in side-to-side anastomoses. METHODS: Two prospective patient cohorts were included: ileocolic resection [ICR] for CD, and right-sided colon resection for colorectal cancer [CRC]. Videos taken during colonoscopy 6 months postoperatively were evaluated. The Simplified Endoscopic Activity Score for Crohn's Disease and modified Rutgeerts score were determined. The primary outcome was the presence of ulcerations in CD patients on both the inverted and the everted stapled lines. Secondary outcomes were the presence of anastomotic ulcerations in CRC patients and the number of cases having ulcerations exclusively at the inverted stapled line. RESULTS: Of the 82 patients included in the CD cohort, ulcerations were present in 63/82 [76.8%] at the inverted- vs 1/71 [1.4%] at the everted stapled line. Likewise in the CRC cohort, ulcerations were present in 4/6 [67.7%] at the inverted vs 0/6 [0%] at the everted stapled line. In total, 27% of the 63 patients in the CD cohort had ulcerations exclusively on the inverted stapled line. CONCLUSION: Inverted stapled lines heal with ulcerations, whereas everted stapled lines heal without any ulcerations, in both CD and non-CD patients. The abnormalities at the inverted stapled line might interfere with endoscopic scoring of recurrence, with potentially an impact on patients' quality of life and on healthcare costs if postoperative treatment is initiated incorrectly.
AB - BACKGROUND AND AIMS: Adequate endoscopic scoring in Crohn's disease [CD] is crucial, as it dictates the need for initiating postoperative medical therapy and is utilized as an outcome parameter in clinical trials. Here we aimed to observe anastomotic wound healing in relation to endoscopic scoring of both inverted and everted stapled lines in side-to-side anastomoses. METHODS: Two prospective patient cohorts were included: ileocolic resection [ICR] for CD, and right-sided colon resection for colorectal cancer [CRC]. Videos taken during colonoscopy 6 months postoperatively were evaluated. The Simplified Endoscopic Activity Score for Crohn's Disease and modified Rutgeerts score were determined. The primary outcome was the presence of ulcerations in CD patients on both the inverted and the everted stapled lines. Secondary outcomes were the presence of anastomotic ulcerations in CRC patients and the number of cases having ulcerations exclusively at the inverted stapled line. RESULTS: Of the 82 patients included in the CD cohort, ulcerations were present in 63/82 [76.8%] at the inverted- vs 1/71 [1.4%] at the everted stapled line. Likewise in the CRC cohort, ulcerations were present in 4/6 [67.7%] at the inverted vs 0/6 [0%] at the everted stapled line. In total, 27% of the 63 patients in the CD cohort had ulcerations exclusively on the inverted stapled line. CONCLUSION: Inverted stapled lines heal with ulcerations, whereas everted stapled lines heal without any ulcerations, in both CD and non-CD patients. The abnormalities at the inverted stapled line might interfere with endoscopic scoring of recurrence, with potentially an impact on patients' quality of life and on healthcare costs if postoperative treatment is initiated incorrectly.
KW - Crohn’s disease
KW - anastomotic wound healing
KW - endoscopic recurrence
KW - ileocolic resection
UR - http://www.scopus.com/inward/record.url?scp=85159547055&partnerID=8YFLogxK
U2 - https://doi.org/10.1093/ecco-jcc/jjac175
DO - https://doi.org/10.1093/ecco-jcc/jjac175
M3 - Article
C2 - 36382539
SN - 1873-9946
VL - 17
SP - 693
EP - 699
JO - Journal of Crohn's & Colitis
JF - Journal of Crohn's & Colitis
IS - 5
ER -