| Background:Crohn’s disease(CD)is a chronic inflammatory bowel disease of unknown etiology,and its endoscopy mostly presents as longitudinal ulcers.Studies have shown that 60% of patients with Crohn’s disease need to undergo at least 1 surgical operation in their lifetime,and the majority of patients have endoscopic recurrence after surgery earlier than the clinical presentation.As clinical practice has evolved in recent years,the relationship between endoscopic observation of intestinal ulcerative features and disease recurrence is controversial.Therefore,this study intends to explore the relationship between early postoperative endoscopic ulcerative lesions and postoperative disease recurrence in CD patients at our center and provide clinical evidence for postoperative management of CD patients,with the aim of earlier and better detection of signs of postoperative recurrence in CD patients and change medical decisions.Methods:We collected the base-line clinical data of CD patients who underwent surgical procedures(ileal and ileocolic resection,ileo-colon anastomosis),attended our hospital from2010.01.01 to 2019.10.30 and those of CRC patients who underwent radical colon cancer resection and ileocolic anastomosis,attended our hospital from 2010.01.01 to 2020.12.30,the graphic reports of colonoscopy and laboratory tests at the time of review in the our hospital within 1 year after surgery.And the prognosis were collected from patients,followed up in 1-1.5 years after the operation,and the last follow-up date was 2021-09-10.Based on the intraoperative pictures of the gastrointestinal endoscopy performed within 1 year after the operation,two physicians with more than 8 years of experience in IBD treatment were invited to evaluate the site and number of ulcers and to complete the Rutgeerts’ score(RS)and modified RS respectively.We statistically analyzed the distribution,number and morphology of ulcers detected by gastrointestinal endoscopy in CD patients and CRC patients,and performed parametric tests to explore the differences between the two groups.To explore whether the endoscopic manifestations,RS and modified RS results and laboratory tests results of CD patients are correlated with clinical recurrence and surgical recurrence.Results : A total of 46 patients with CD and 26 patients with CRC were included.The modified RS results of CD patients in this study are: i0: 20 cases;i1: 5 cases;i2a: 17 cases;i2b: 1 case;i3: 1case;i4: 1 case.There was no statistically significant difference between the number of ulcers in CD and CRC patients,distributions including : proximal to the anastomosis,at the anastomosis,and distal to the anastomosis.Among CD patients,67.4%(n=31/46)maintained clinical remission,32.6%(n=15/46)had clinical recurrence,and 8.7%(n=4/46)had surgical recurrence as of the follow-up date(2021-09-10).The correlation between i3 and i4 stage of classical RS and modified RS in CD patients and surgical recurrence was statistically significant rather than lower scores.Both classical and modified RS were significantly correlated with Fecal calprotectin(FC),recently in endoscopic examination.The correlation with clinical recurrence and surgical recurrence was not statistically significant in the anastomotic ulcer group and the ileal ulcer group of CD patients.Conclusion: The incidence and distribution of ulcers at the terminal ileum,ileocolic anastomosis,and colorectum did not differ significantly between CD and non-CD patients.The socre of i3 and i4 of the classical RS and modified RS in CD patients predicted surgical recurrence but not clinical recurrence in CD patients.The socre of i3 and i4 of the classical RS and modified RS scores in CD patients were significantly correlated with recent endoscopic FC levels,validating the association between FC levels and intestinal injury.Ulcers at different sites in CD patients were not significantly correlated with FC levels,and ulcers at the anastomosis in CD patients did not suggest more clinical or surgical recurrence than those at other sites,and more clinical trials are needed to confirm this conclusion. |
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