Previous Stricturing Increases Risk of Anastomotic Stricture in Postoperative CD

The risk of anastomotic stricture in patients with postoperative Crohn’s disease (CD) is not affected by anastomotic configuration, temporary diverting ileostomy, or ileal CD, but is increased with previous stricturing disease behavior. Researchers published their findings in The American Journal of Gastroenterology.

“Early detection and intervention for anastomotic stricturing may help prevent progression to repeat ileocolonic resection,” wrote corresponding author Benjamin H. Click, MD, MS, of the Cleveland Clinic, Cleveland, Ohio, and the University of Colorado Anschutz Medical Campus, Aurora, Colorado, and study coauthors.

The retrospective investigation included 602 adults with CD who underwent ileocolonic resection with postoperative ileocolonoscopy between 2009 and 2020. At the time of ileocolonic resection, 426 patients had primary anastomosis, and 136 patients had temporary diversion. Anastomotic configurations included 308 side-to-side, 148 end-to-side, and 136 end-to-end anastomoses.

According to the analysis, 18.3% of patients developed anastomotic stricturing. The median time to detection was 3.2 years. The severity of anastomotic stricturing at detection was associated with the need for repeat surgical resection.

Anastomotic configuration and temporary diverting ileostomy were associated with neither the risk of, nor the time to, anastomotic stricturing, multivariable Cox proportional hazard regression indicated. Furthermore, endoscopic ileal recurrence before anastomotic stricturing was not linked with subsequent detection of anastomotic stricturing.

“Preoperative stricturing disease was associated with decreased time to anastomotic stricturing (adjusted hazard ratio 1.8; P = 0.049),” researchers reported.

Reference:
Bachour SP, Khan MZ, Shah RS, et al. Anastomotic configuration and temporary diverting ileostomy do not increase risk of anastomotic stricture in postoperative Crohn’s disease. Am J Gastroenterol. 2023;118(12):2212-2219. doi:10.14309/ajg.0000000000002393