Combined Clinical and Histopathological Risk Stratification for Prediction of (severe) Endoscopic Postoperative Recurrence in Patients with Crohn’s Disease after Ileocolic Resection
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Le résumé fourni par la source
OBJECTIVE: This study assessed the association of histopathological features in the resection specimen of CD patients with (severe) endoscopic postoperative recurrence (ePOR) in a large prospective, multicenter cohort study. SUMMARY BACKGROUND DATA: The predictive value of histopathologic features of the intestinal resection specimen for the risk of Crohn's disease (CD) recurrence after ileocolic (re-)resection (ICR) remains a matter of debate. METHODS: CD patients (≥16 y) scheduled for ICR (n=293) were included. Outcome measures were ePOR (modified Rutgeerts' score ≥i2b) and severe ePOR (≥i3) at six months postoperatively. Histopathological assessment of resection margins and mesentery/mesocolon was performed by expert gastrointestinal pathologists. Logistic regression was performed and ROC curves were delineated to explore the association and accuracy of histopathology with (severe) ePOR. RESULTS: ePOR and severe ePOR was observed in 37% and 9% of patients. Only moderate to severe inflammation at the ileal resection margin (OR 2.5; 95%CI 1.1-5.6) was associated with ePOR in multivariable analysis. Area under the curve for individual histopathological risk factors varied between 0.53-0.58 for ePOR (active inflammation at the resection margins, submucosal plexitis and transmural inflammation) and 0.69-0.71 for severe ePOR (submucosal plexitis, transmural inflammation and mesenteric granulomas). Clinical risk factors alone (active smoking and postoperative prophylactic medication) had an AUC of 0.66 and 0.74 for ePOR and severe ePOR. Combined histopathological and clinical risk stratification increased the AUC up to 0.71 for ePOR and up to 0.79 for severe ePOR. CONCLUSIONS: Only moderate to severe inflammation at the ileal margin was independently associated with ePOR. A combined approach of clinical risk stratification and assessment of histopathological features in the resection specimen provides an adequate predictive value for (severe) ePOR after ICR in patients with CD.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Combined Clinical and Histopathological Risk Stratification for Prediction of (severe) Endoscopic Postoperative Recurrence in Patients with Crohn’s Disease after Ileocolic Resection
- Date Crossref
- 08/05/2025
- Éditeur
- Ovid Technologies (Wolters Kluwer Health)
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Erasmus MC pays non établi dans la noticeÉtablissement de santé
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PathoFinder (Netherlands) pays non établi dans la noticeEntreprise
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Flevoziekenhuis pays non établi dans la noticeÉtablissement de santé
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Zuyderland Medisch Centrum pays non établi dans la noticeÉtablissement de santé
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University Medical Center Groningen Department of Gastroenterology and Hepatology pays non établi dans la noticeÉtablissement de santé
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University of Groningen pays non établi dans la noticeUniversité ou école supérieure
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Radboud University Nijmegen pays non établi dans la noticeUniversité ou école supérieure
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Radboud University Medical Center Department of Gastroenterology and Hepatology pays non établi dans la noticeOrganisme public
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Medisch Centrum Haaglanden pays non établi dans la noticeÉtablissement de santé
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Maastricht University Department of Surgery pays non établi dans la noticeUniversité ou école supérieure
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Leiden University Medical Center Department of Gastroenterology and Hepatology pays non établi dans la noticeOrganisme public
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Amsterdam University Medical Centers Department of Surgery pays non établi dans la noticeÉtablissement de santé
Erasmus MC, PathoFinder (Netherlands) et Flevoziekenhuis, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.