Introduction Disease recurrence after surgical resection for Crohn's disease (CD) is observed in 20%–30% of patients at 1 year, with a 10% increase per year in subsequent years. The European Crohn's and Colitis Organisation currently recommends ileo-colonoscopy 1 year after ileo-colic resection, since this predicts the need for further surgery (Statement 8C) within 2 years.1 This statement is not supported by the BSG guidelines, highlighting a need for prospective studies to determine the role of the Rutgeert's score following ileo-colic resection. The aim of this study was to determine if the Rutgeert's score3 at 1–2 years after ileo-colic resection predicts clinical recurrence and/or need for further surgery in patients with CD in district general hospital practice.
Methods Between 2005 and 2011, 43 patients with fibrostenotic or penetrating terminal ileal or right sided CD underwent ileo-colic resection. Ileo-colonoscopy was performed in 34 asymptomatic patients between 1 and 2 years following surgery. A single expert observer (AWH) assessed the surgical anastomosis to determine the Rutgeerts' score3 (i0–i4). Nine patients who underwent resection were excluded either because ileo-colonoscopy was unsuccessful or the patient refused endoscopic assessment.
Results 14 of 15 (93%) patients with Rutgeert's scores i0 or i1 remained asymptomatic from CD (Harvey Bradshaw Index ≤4) at January 2012 (range of follow-up 4–69 months, mean of 30 months after ileo-colonoscopy). Three (20%) of these patients smoked. Of 19 patients scoring i2 to i4, 12 (63%) had clinical recurrence requiring medical treatment with immunosuppression and/or biologics. 47% of patients with a Rutgeert's score of i2–i4 and 50% of those with clinical recurrence were current smokers.
Conclusion In district general hospital practice, a low Rutgeert's score (i0 or i1) at 1–2 years after ileo-colic resection for CD predicts prolonged clinical remission without the need for medical treatment. By contrast, in those patients with a Rutgeert's scores ≥i2 clinical recurrence occurred within a maximum of 16 months following surgical resection with a higher rate of recurrence among smokers.
Competing interests None declared.
References 1. Van Assche G. The second European evidence-based Consensus on the diagnosis and management of Crohn's disease: Special situations. J Crohns Colitis 2010;4:63–101.
2. BSG IBD Guidelines 2011:6.6.3 Postoperative management: preventing postoperative recurrence.
3. Rutgeerts P, Geboes K, Vantrappen G. Natural history of recurrent Crohn's disease at the ileocolonic anastomosis after curative surgery. Gut 1984;25:665–72.
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