Comparison of the risk of Crohn's disease postoperative recurrence between modified Rutgeerts score i2a and i2b categories: an individual patient data meta-analysis
2022
Rivière, Pauline | Pekow, Joel | Hammoudi, Nassim | Wils, Pauline | de Cruz, Peter | Wang, Christina Pu | Mañosa, Miriam | Ollech, Jacob | Allez, Matthieu | Nachury, Maria | Kamm, Michael A. | Ahanori, Maya | Ferrante, Marc | Buisson, Anthony | Singh, Siddarth | Laharie, David | Diouf, Momar | Fumery, Mathurin | Hôpital Haut-Lévêque [CHU Bordeaux] ; Centre Hospitalier Universitaire de Bordeaux (CHU Bordeaux) | The University of Chicago Medicine [Chicago] | Ecotaxie, microenvironnement et développement lymphocytaire (EMily (UMR_S_1160 / U1160)) ; Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité) | Hopital Saint-Louis [AP-HP] (AP-HP) ; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP) | Institute for Translational Research in Inflammation - U 1286 (INFINITE) ; Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [CHU Lille] (CHRU Lille) | Austin Health | Icahn School of Medicine at Mount Sinai [New York] (MSSM) | Hospital Universitari Germans Trias I Pujol | University of Chicago | St. Vincent's Hospital, Melbourne | University of Melbourne | Universitair Ziekenhuis Leuven = University Hospital of Leuven = Hopital universitaire de Louvain (UZ Leuven) | Service Hépato-Gastro-Entérologie [CHU Clermont-Ferrand] ; CHU Estaing [Clermont-Ferrand] ; CHU Clermont-Ferrand-CHU Clermont-Ferrand-Pôle Spécialités médicales et chirurgicales [CHU Clermont-Ferrand] ; CHU Clermont-Ferrand | Infection Inflammation et Interaction Hôtes Pathogènes [CHU Clermont-Ferrand] (3IHP) ; Direction de la Recherche Clinique et de l’Innovation [CHU Clermont-Ferrand] (DRCI) ; CHU Clermont-Ferrand-CHU Clermont-Ferrand | Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte (M2iSH) ; Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre de Recherche en Nutrition Humaine d'Auvergne (CRNH d'Auvergne)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Université Clermont Auvergne (UCA) | University of California [San Diego] (UC San Diego) ; University of California (UC) | CHU Amiens-Picardie | Périnatalité et Risques Toxiques - UMR INERIS_I 1 UPJV (PERITOX) ; Institut National de l'Environnement Industriel et des Risques (INERIS)-Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie
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Show more [+] Less [-]English. BACKGROUND: The modified Rutgeerts' score differentiates i2a - lesions confined to the anastomosis - and i2b - more than 5 aphthous ulcers in the neoterminal ileum with normal intervening mucosa, with or without anastomotic lesions - categories. Its relevance for the therapeutic management of Crohn's disease (CD) patients after ileocolic resection is still debated. Our objective was to compare the postoperative recurrence risk in patients with an i2a or i2b score using an individual patient data meta-analysis. METHODS: We conducted a systematic literature search until July 2020 to identify all relevant studies reporting the i2a/i2b status in the year following ileocolic resection and clinical and/or surgical postoperative CD recurrence in their follow-up. Individual patient level data were obtained from the cRESULTS: Seven studies published between 2008 and 2019 were included corresponding to 400 patients: 189 (47%) i2a and 211 (53%) i2b. Median (interquartile range, IQR) time from ileocolic resection to ileocolonoscopy was 6.2 (5.5, 7.9) months and median (IQR) follow-up time after ileocolonoscopy was 4.5 (2.9, 7.3) years. The risk of clinical postoperative recurrence at 1 and 3 years was 11% [6%-15%], and 25% [18%-32%] in the i2a group versus 9% [5%-13%] and 33% [26%-41%] in the i2b group (p=0.63 and p=0.12, respectively). No significant difference was observed in terms of time to clinical postoperative recurrence (p=0.16) or surgical postoperative recurrence (p=0.87). Results did not change after excluding patients having initiated an immunosuppressant or a biologic in the three months after endoscopy (remaining cohort, n=361). CONCLUSION: In this individual patient data meta-analysis, no difference was observed between i2a and i2b subcategories with regards to clinical or surgical postoperative recurrence. As we wait for prospective trials, the same treatment strategy could be applied to all patients classified as i2 on the Rutgeerts score.
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