Recurrence patterns after first resection for stricturing or penetrating Crohn's disease

David B. Sachar, Eric Lemmer, Christopher Ibrahim, Yair Edden, Thomas A. Ullman, Julie Ciardulo, Esther Roth, Adrian J. Greenstein, Joel J. Bauer

Research output: Contribution to journalArticle

54 Citations (Scopus)

Abstract

Background: Crohn's disease (CD) usually recurs after resection, but the factors associated with this risk remain obscure. We set out to determine the role of stricturing (Montreal Classification B2) versus penetrating (Classification B3) disease behavior in predicting early (<3 years) versus late (≥3 years) postoperative recurrence. Methods: We identified a cohort of 34 patients seen at The Mount Sinai Hospital who had undergone a first ileocolic resection prior to December 31, 2004, who had been clinically thought to have had stricturing (B2) disease, and for whom we could verify 1) the operative and surgical pathology findings; and 2) the time of onset of symptoms attributable to recurrent CD by endoscopy, radiology, or surgery. Cases were reclassified as either "stricturing" (B2) or "penetrating" (B3) on the basis of operative and surgical pathology reports. Recurrences were classified as either "early" (<3 years) or "late" (≥3 years) depending on the first appearance of postoperative symptoms that were verified endoscopically and histologically, radiologically, or surgically as being attributable to anastomotic recurrence of the CD. Results: Among these 34 patients clinically thought to have had B2 disease, 12 had B2 disease confirmed upon review of surgical and pathology reports and none of them had recurrence within 3 years. Among the 22 patients reclassified as B3 disease, 12 (55%) had early recurrence. This difference was significant at the 0.002 level by the Fisher Exact Test. Conclusions: There is a strong proclivity for early postoperative recurrence of penetrating CD compared to stricturing disease, which may not be evident by behavioral classification on clinical grounds alone. Patients with confirmed uncomplicated stricturing obstruction at their first resection seem unlikely to experience a clinical recurrence within the next 3 years.

Original languageEnglish (US)
Pages (from-to)1071-1075
Number of pages5
JournalInflammatory Bowel Diseases
Volume15
Issue number7
DOIs
StatePublished - Sep 18 2009
Externally publishedYes

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Crohn Disease
Recurrence
Surgical Pathology
Radiology
Endoscopy

Keywords

  • Classification
  • Crohn's surgery
  • Recurrence

ASJC Scopus subject areas

  • Immunology and Allergy
  • Gastroenterology

Cite this

Sachar, D. B., Lemmer, E., Ibrahim, C., Edden, Y., Ullman, T. A., Ciardulo, J., ... Bauer, J. J. (2009). Recurrence patterns after first resection for stricturing or penetrating Crohn's disease. Inflammatory Bowel Diseases, 15(7), 1071-1075. https://doi.org/10.1002/ibd.20872

Recurrence patterns after first resection for stricturing or penetrating Crohn's disease. / Sachar, David B.; Lemmer, Eric; Ibrahim, Christopher; Edden, Yair; Ullman, Thomas A.; Ciardulo, Julie; Roth, Esther; Greenstein, Adrian J.; Bauer, Joel J.

In: Inflammatory Bowel Diseases, Vol. 15, No. 7, 18.09.2009, p. 1071-1075.

Research output: Contribution to journalArticle

Sachar, DB, Lemmer, E, Ibrahim, C, Edden, Y, Ullman, TA, Ciardulo, J, Roth, E, Greenstein, AJ & Bauer, JJ 2009, 'Recurrence patterns after first resection for stricturing or penetrating Crohn's disease', Inflammatory Bowel Diseases, vol. 15, no. 7, pp. 1071-1075. https://doi.org/10.1002/ibd.20872
Sachar, David B. ; Lemmer, Eric ; Ibrahim, Christopher ; Edden, Yair ; Ullman, Thomas A. ; Ciardulo, Julie ; Roth, Esther ; Greenstein, Adrian J. ; Bauer, Joel J. / Recurrence patterns after first resection for stricturing or penetrating Crohn's disease. In: Inflammatory Bowel Diseases. 2009 ; Vol. 15, No. 7. pp. 1071-1075.
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AU - Sachar, David B.

AU - Lemmer, Eric

AU - Ibrahim, Christopher

AU - Edden, Yair

AU - Ullman, Thomas A.

AU - Ciardulo, Julie

AU - Roth, Esther

AU - Greenstein, Adrian J.

AU - Bauer, Joel J.

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N2 - Background: Crohn's disease (CD) usually recurs after resection, but the factors associated with this risk remain obscure. We set out to determine the role of stricturing (Montreal Classification B2) versus penetrating (Classification B3) disease behavior in predicting early (<3 years) versus late (≥3 years) postoperative recurrence. Methods: We identified a cohort of 34 patients seen at The Mount Sinai Hospital who had undergone a first ileocolic resection prior to December 31, 2004, who had been clinically thought to have had stricturing (B2) disease, and for whom we could verify 1) the operative and surgical pathology findings; and 2) the time of onset of symptoms attributable to recurrent CD by endoscopy, radiology, or surgery. Cases were reclassified as either "stricturing" (B2) or "penetrating" (B3) on the basis of operative and surgical pathology reports. Recurrences were classified as either "early" (<3 years) or "late" (≥3 years) depending on the first appearance of postoperative symptoms that were verified endoscopically and histologically, radiologically, or surgically as being attributable to anastomotic recurrence of the CD. Results: Among these 34 patients clinically thought to have had B2 disease, 12 had B2 disease confirmed upon review of surgical and pathology reports and none of them had recurrence within 3 years. Among the 22 patients reclassified as B3 disease, 12 (55%) had early recurrence. This difference was significant at the 0.002 level by the Fisher Exact Test. Conclusions: There is a strong proclivity for early postoperative recurrence of penetrating CD compared to stricturing disease, which may not be evident by behavioral classification on clinical grounds alone. Patients with confirmed uncomplicated stricturing obstruction at their first resection seem unlikely to experience a clinical recurrence within the next 3 years.

AB - Background: Crohn's disease (CD) usually recurs after resection, but the factors associated with this risk remain obscure. We set out to determine the role of stricturing (Montreal Classification B2) versus penetrating (Classification B3) disease behavior in predicting early (<3 years) versus late (≥3 years) postoperative recurrence. Methods: We identified a cohort of 34 patients seen at The Mount Sinai Hospital who had undergone a first ileocolic resection prior to December 31, 2004, who had been clinically thought to have had stricturing (B2) disease, and for whom we could verify 1) the operative and surgical pathology findings; and 2) the time of onset of symptoms attributable to recurrent CD by endoscopy, radiology, or surgery. Cases were reclassified as either "stricturing" (B2) or "penetrating" (B3) on the basis of operative and surgical pathology reports. Recurrences were classified as either "early" (<3 years) or "late" (≥3 years) depending on the first appearance of postoperative symptoms that were verified endoscopically and histologically, radiologically, or surgically as being attributable to anastomotic recurrence of the CD. Results: Among these 34 patients clinically thought to have had B2 disease, 12 had B2 disease confirmed upon review of surgical and pathology reports and none of them had recurrence within 3 years. Among the 22 patients reclassified as B3 disease, 12 (55%) had early recurrence. This difference was significant at the 0.002 level by the Fisher Exact Test. Conclusions: There is a strong proclivity for early postoperative recurrence of penetrating CD compared to stricturing disease, which may not be evident by behavioral classification on clinical grounds alone. Patients with confirmed uncomplicated stricturing obstruction at their first resection seem unlikely to experience a clinical recurrence within the next 3 years.

KW - Classification

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