Predictive Value of the REMIND Endoscopic Score for Clinical Recurrence After Ileocolic Resection in Crohn's Disease
##plugins.themes.academic_pro.article.main##
Abstract
Background: This study evaluates the REMIND score’s performance in predicting postoperative Crohn’s disease recurrence compared to the Rutgeerts score, which has the limitation of grouping anastomotic and neo-terminal ileal lesions together with equal prognostic value.
Methods: We conducted a monocentric, retrospective, evaluative study of patients operated for Crohn’s disease. All patients had a follow-up colonoscopy within one year of surgery. Clinical relapse was defined by the Crohn’s disease related symptoms or complications, such as intra-
abdominal collection or occlusion, or subsequent postoperative surgery. Data analysis was performed using SPSS.25.
Results: Eighty patients were included. Clinical recurrence-free survival was significantly shorter in patients with ileal lesions whatever their severity was I(1,2,3,4)A(x), compared with patients without ileal lesions I(0)A(x): p<0,001 and not significantly different between patients without
anastomotic lesions I(x)A(0) and patients with anastomotic lesions whatever their severity was I(x)A(1,2,3): p=0,2. However, patients with at least semicircumferential anastomotic ulcerations A(2,3) had more anastomotic occlusive complications than patients classified A0 or A1: A0 VS A2 p=0,01 A0 VS A3 p<0,001 A0 VS A1 p=0,9. The I(x) score, compared with the Rutgeerts and A(x) scores, had the best values in terms of discriminative capacity (Area under the curve= 0,83 VS 0,73 VS 0,61), monotonicity (linearity test χ2 of 26,77 VS 12,36 VS 3,89), and homogeneity (likelihood ratio χ2 of 33,91 vs 18,45 VS 5,49).
Conclusion: The I(x) score outperformed both the Rutgeerts and A(x) scores in predicting postoperative recurrence. Consequently, evaluating ileal and anastomotic lesions separately provides a more accurate assessment of endoscopic recurrence
Keywords:
Crohn's disease, Surgery, Recurrence, Rutgeerts score, Endoscopy, REMIND score##plugins.themes.academic_pro.article.details##
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
- Nguyen GC, Loftus EV, Hirano I, Falck–Ytter Y, Singh S, Sultan S, et al. American Gastroenterological Association Institute Guideline
- on the Management of Crohn’s Disease After Surgical Resection. Gastroenterology. jan 2017;152(1):271-5.
- Frolkis AD, Dykeman J, Negrón ME, deBruyn J, Jette N, Fiest KM, et al. Risk of Surgery for Inflammatory Bowel Diseases Has Decreased
- Over Time: A Systematic Review and Meta-analysis of Population- Based Studies. Gastroenterology. nov 2013;145(5):996-1006.
- Peyrin-Biroulet L, Loftus EV, Colombel JF, Sandborn WJ. The Natural History of Adult Crohn’s Disease in Population-Based Cohorts.
- American Journal of Gastroenterology. feb 2010;105(2):289-97.
- Rutgeerts P, Geboes K, Vantrappen G, Kerremans R, Coenegrachts JL, Coremans G. Natural history of recurrent Crohn’s disease at
- the ileocolonic anastomosis after curative surgery. Gut. 1 june 1984;25(6):665-72.
- Rutgeerts P, Geboes K, Vantrappen G, Beyls J, Kerremans R, Hiele M. Predictability of the postoperative course of Crohn’s disease.
- Gastroenterology. oct 1990;99(4):956-63.
- Hammoudi N, Auzolle C, Tran Minh ML, Boschetti G, Bezault M, Buisson A, et al. Postoperative Endoscopic Recurrence on the
- Neoterminal Ileum But Not on the Anastomosis Is Mainly Driving Long-Term Outcomes in Crohn’s Disease. Am J Gastroenterol. july
- ;115(7):1084-93.
- Chari ST, Keate RF. Ileocolonic Anastomotic Ulcers: A Case Series and Review of The Literature. American Journal of Gastroenterology.
- may 2000;95(5):1239-43.
- Fusaro F, Tambucci R, Romeo E, Bagolan P, Dall’Oglio L, Ceccarelli S, et al. Anastomotic ulcers in short bowel syndrome: New
- suggestions from a multidisciplinary approach. Journal of Pediatric Surgery. march 2018;53(3):483-8.