The impact of early endoscopic lesions on the clinical course of patients following ileocolonic resection for Crohn's disease: A 5-year prospective cohort study

Background: Early endoscopic lesions following resection for Crohn's disease (CD) are often observed. Currently, the relationship between this endoscopic observation and subsequent occurrence of CD lesions or recurrence is not understood well, but should be valuable in the context of predicting CD course. This prospective study was to investigate the impact of early endoscopic lesions on future clinical recurrence rates following ileocolonic resection for CD. Methods: Forty patients who had maintained clinical remission, CD activity index (CDAI) < 150 with mesalazine during 6 months after ileocolonic resection for CD were included. At 6 months after surgery, ileocolonoscopy was performed, and the endoscopic activity score at the proximal site of the anastomosis was determined according to Rutgeerts. All patients were regularly monitored for 5 years, and clinical recurrence was defined as CDAI >= 150. Corticosteroids, immunosuppressants, or biological agents were not given unless there was clinical recurrence. Results: At 6 months after surgery, the endoscopic scores were i0 or i1 in 27 patients, i2 in seven patients, i3 in four patients, and i4 in two patients. During the following 5 years, the clinical recurrence occurred in three (11%) patients with endoscopic score of i0 or i1, four (57%) patients with i2 score, three (75%) patients with i3 score, and two (100%) patients with i4 score, showing a significant positive correlation (p = 0.001) between the endoscopic severity of the proximal site of the anastomosis at 6 months after surgery and the clinical recurrence rate during the following 5 years. Conclusions: The assessment of endoscopic lesions at the proximal site of the anastomosis appeared to be valuable for predicting subsequent clinical recurrence after ileocolonic resection for CD. Further studies in larger cohorts of patients are warranted to strengthen our findings.