摘要
Background:Recurrence of Crohn’s disease(CD)can occur after surgery,including end ileostomy(EI).The Rutgeerts score(RS)was developed to predict postsurgical CD recurrence via ileocolonoscopy in patients having ileocolonic resection.The role of ileoscopic evaluation via stoma for assessing recurrence of CD has not been investigated.The aim of this study was to evaluate the role of ileoscopy for predicting disease recurrence in CD patients after EI with the use of RS.Methods:A total of 73 eligible CD patients with at least two ileoscopies in our institution following EI were included.Mucosal inflammation of the neo-terminal ileum was graded based on the RS.The primary outcomes were the need for endoscopic stricture dilation and subsequent surgery due to recurrence of disease.The secondary outcomes were CDrelated hospitalization and the need to escalate CD-associated medications.Results:The median duration of CD until EI was 9 years(interquartile range:4-13 years),and themedian duration from EI to the first ileoscopy was 28months(interquartile range:11-93 months).The RSs in the neo-terminal ileum close to EI were calculated,and subjects were divided into two groups:the normal RS group with the score being zero(n=25)and the abnormal RS group with the RS score being(n=48).Patients in the abnormal RS group weremore likely to have recurrence of CD(92%vs 27%)and need endoscopic dilation of stricture(40%vs 10%),subsequent bowel surgery(68%vs 15%),disease-related hospitalizations(80%vs 23%)and escalation of CDmedications(64%vs 25%)than those in the normal RS group.Time-to-event analysis showed that patients in the abnormal RS group were at a higher risk of endoscopic dilation(odds ratio(OR)=1.5;95%CI:1.09–1.9),need of second bowel surgery(OR=1.5;95% CI:1.2–1.8)and disease-related hospitalizations(OR=1.3;95% CI:1.1–1.6)after adjusting for factors such as duration from surgery to sensor,duration of disease and the patient’s sex(all P<0.001).Further multivariable analysis showed that patients in the abnormal RS group were more likely to need escalation of CD-related medications after adjusting for duration from surgery and age(OR¼5.3;95%CI:1.7–16.5;P=0.004).Conclusion:RS can be used to predict the recurrence of CD in patients with EI.A high RS score based on ileoscopy appeared to be associated with poor outcomes.This may be considered a useful decision-making tool for monitoring disease after ileostomy surgery.
背景:克罗恩病(CD)患者术后(包括末端回肠造口术)会出现复发。对于回结肠切除术患者,术后可以通过回结肠镜进行Rutgeerts评分,从而预测术后CD的临床复发。而通过回肠造口进行的回肠镜评估对于术后CD复发的预测价值,目前尚未见报道。本研究旨在评估回肠镜下Rutgeerts评分对于CD患者末端回肠造口术后疾病复发的预测价值。方法:共有73例行末端回肠造口术的CD患者纳入研究,所有入组病例术后均在本中心接受了至少2次的回肠镜评估。基于Rutgeerts评分对新末端回肠的黏膜炎症程度进行分级。主要结局指标是由于疾病复发需要行内镜扩张治疗或再次手术治疗,次要结局指标是CD相关住院治疗和需要升级CD治疗药物。结果:本组病例CD发病至行末端回肠造口术的中位间期为9年(四位分间距:413年),造口术至首次回肠镜检查的中位间期为28月(四位分间距:1193月)。对靠近造口处的新末端回肠进行Rutgeerts评分,并据此将患者分为两组:Rutgeerts评分0分者为正常评分组(25例),≥1分者为异常评分组(48例)。异常评分组患者疾病复发(92%vs 27%)、需要行内镜扩张治疗(40%vs 10%)、再次肠道手术(68%vs 15%)、住院治疗(80%vs 23%)以及CD治疗药物升级的概率高于正常评分组。事件发生时间(time-to-event)分析显示,对手术至首次内镜评估的时间、疾病病程和患者性别等因素进行调整后,异常评分组患者需要行内镜扩张(HR=1.5,95%CI:1.09–1.9)、再次肠道手术(HR=1.5,95%CI:1.2–1.8)和住院治疗(HR=1.3,95%CI:1.1–1.6)的风险显著增高。多因素分析显示,对手术至初次内镜评估的时间和患者年龄进行调整后,异常评分组患者需要升级CD治疗药物的风险亦明显增高(OR=5.3,95%CI:1.7–16.5;P=0.004)。结论:Rutgeerts评分可用以预测末端回肠造口患者的CD复发。回肠镜评估的高Rutgeerts评分患者预后不良。基于回肠镜的Rutgeerts评分是末端回肠造口术后疾病监测的有效工具。
