Post written by Jacob E. Ollech, MD, from the Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Illinois, USA.
This studied determined whether isolated anastomotic ulcers (Rutgeerts score i2a), or 5 or more aphthous ulcers within the neoterminal ileum (i2b) predict an increased risk of endoscopic disease progression.
Endoscopic recurrence occurs frequently after ileocolic resection in patients with Crohn’s disease, and subclassification of i2 lesions may help identify patients at the greatest risk of recurrence who would receive the most benefit from intensive monitoring and prophylaxis. Unnecessary treatment in patients with a low risk of recurrence may also be prevented.
This study suggests that i2a and i2b lesions have different risks of disease progression. We recommend escalation of medical therapy in patients with i2b lesions; however, we propose that patients with lesions confined to the anastomosis (i2a) may be followed closely without treatment escalation as these lesions seem to have a lower risk of endoscopic disease progression. A randomized prospective study would be best equipped to answer this question.
Figure 1. Time to endoscopic progression based on Rutgeert score (RS) at the initial postoperative colonoscopy. Kaplan-Meier curves of time from first postoperative colonoscopy to RS of i3 to i4. Blue line, RS 0 to 1; red line, RS 2a; green line, RS 2b.
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