Crohn Disease Postop Recurrence Scoring Needs Updating

The evolution of surgical techniques for Crohn disease in recent years makes it necessary to update postoperative endoscopic recurrence scoring, advises a paper published online ahead of print in Clinical Gastroenterology and Hepatology.

“The Rutgeerts score, designed 30 years ago, was constructed based on lesions observed in patients with end-to-end anastomosis,” wrote lead author Pauline Rivière, MD, of the Université de Bordeaux in France, and coauthors. “Today’s leading surgical techniques, the side-to-side and side-to-end anastomosis, design anatomic locations ignored by the Rutgeerts score, ie the inlet of the neoterminal ileum and the ileal segment (ileal body) facing the colon.”

To better assess endoscopic recurrence of Crohn disease, the authors suggest adaptations to postoperative endoscopic recurrence scoring that take into account anatomic locations affected by side-to-side and side-to-end anastomosis. Specifically, they advise restricting the term anastomotic line to the 1 cm above and below the stapled or hand-sewn junction of the ileum and the colon created by the surgeon. The term ileal inlet, meanwhile, should be added to refer to the 1 cm above and below the entry of the neoterminal ileum, which represents the critical diameter of the anastomosis and a site of high interest in gauging postoperative recurrence.

The authors further propose adding the terms ileal body, ileal blind loop, and colonic blind loop for side-to-end and side-to-side anastomosis scoring—and the creation of a new postoperative recurrence score that takes them into consideration. The score, they continued, should differentiate lesions distal from the ileal inlet in side-to-side anastomosis, lesions in the neoterminal ileum proximal to the ileal inlet, and lesions confined to the ileal inlet.

“However, this reflects our opinion, and actual data from real-life studies and randomized controlled trials will be needed to confirm or not the relevance of the classification we propose,” the authors wrote. “This new terminology should be evaluated first by testing intra- and inter-observer variability of new anastomotic locations identification and scoring. Next, a prospective study should assess the predictive value of this new score compared to the original Rutgeerts score.”

—Jolynn Tumolo

Reference

Rivière P, Bislenghi G, Vermeire S, et al. Postoperative Crohn's disease recurrence: time to adapt endoscopic recurrence scores to the leading surgical techniques. Clin Gastroenterol Hepatol. Published online ahead of print February 17, 2020.