TY - JOUR
T1 - Systematic review
T2 - Patient-related, microbial, surgical, and histopathological risk factors for endoscopic post-operative recurrence in patients with Crohn's disease
AU - Bak, Michiel T. J.
AU - Demers, Karlijn
AU - Hammoudi, Nassim
AU - Allez, Matthieu
AU - Silverberg, Mark S.
AU - Fuhler, Gwenny M.
AU - Parikh, Kaushal
AU - Pierik, Marieke J.
AU - Stassen, Laurents P. S.
AU - van der Woude, C. Janneke
AU - Doukas, Michail
AU - van Ruler, Oddeke
AU - de Vries, Annemarie C.
PY - 2024/8
Y1 - 2024/8
N2 - Background: Risk stratification for endoscopic post-operative recurrence (ePOR) in Crohn's disease (CD) is required to identify patients who would benefit most from initiation of prophylactic medication and intensive monitoring of recurrence. Aims: To assess the current evidence on patient-related, microbial, surgical and histopathological risk factors for ePOR in patients with CD after ileocolic (re-)resection. Methods: Multiple online databases (Embase, MEDLINE, Web of Science and Cochrane Library) were searched up to March 2024. Studies with reported associations of patient-related, microbial, surgical and/or histopathological factors for ePOR (i.e., Rutgeerts’ score ≥i2 or modified Rutgeerts’ score ≥i2a) were included. The risk of bias was assessed with the Newcastle-Ottawa Scale for observational cohort studies and case-control studies. Results: In total, 47 studies were included (four RCTs, 29 cohort studies, 12 case–control studies, one cross-sectional study and one individual participant data meta-analysis) including 6006 patients (median sample size 87 patients [interquartile range 46–170]). Risk of bias assessment revealed a poor quality in 41% of the studies. An association was reported in multiple studies of ePOR with active smoking at and post-surgery, male sex and prior bowel resection. A heterogeneous association with ePOR was reported for other risk factors included in the current guidelines (penetrating disease, perianal disease, younger age, extensive small bowel disease and presence of granulomas in the resection specimen or myenteric plexitis in the resection margin), and other patient-related, microbial, surgical and histopathological factors. Conclusion: Risk factors for ePOR in international guidelines are not consistently reported as risk factors in current literature except for active smoking and prior bowel resection. To develop evidence-based, personalised strategies, large prospective studies are warranted to identify risk factors for ePOR. Validation studies of promising (bio)markers are also required.
AB - Background: Risk stratification for endoscopic post-operative recurrence (ePOR) in Crohn's disease (CD) is required to identify patients who would benefit most from initiation of prophylactic medication and intensive monitoring of recurrence. Aims: To assess the current evidence on patient-related, microbial, surgical and histopathological risk factors for ePOR in patients with CD after ileocolic (re-)resection. Methods: Multiple online databases (Embase, MEDLINE, Web of Science and Cochrane Library) were searched up to March 2024. Studies with reported associations of patient-related, microbial, surgical and/or histopathological factors for ePOR (i.e., Rutgeerts’ score ≥i2 or modified Rutgeerts’ score ≥i2a) were included. The risk of bias was assessed with the Newcastle-Ottawa Scale for observational cohort studies and case-control studies. Results: In total, 47 studies were included (four RCTs, 29 cohort studies, 12 case–control studies, one cross-sectional study and one individual participant data meta-analysis) including 6006 patients (median sample size 87 patients [interquartile range 46–170]). Risk of bias assessment revealed a poor quality in 41% of the studies. An association was reported in multiple studies of ePOR with active smoking at and post-surgery, male sex and prior bowel resection. A heterogeneous association with ePOR was reported for other risk factors included in the current guidelines (penetrating disease, perianal disease, younger age, extensive small bowel disease and presence of granulomas in the resection specimen or myenteric plexitis in the resection margin), and other patient-related, microbial, surgical and histopathological factors. Conclusion: Risk factors for ePOR in international guidelines are not consistently reported as risk factors in current literature except for active smoking and prior bowel resection. To develop evidence-based, personalised strategies, large prospective studies are warranted to identify risk factors for ePOR. Validation studies of promising (bio)markers are also required.
KW - ILEOCOLIC RESECTION
KW - INTESTINAL RESECTION
KW - NATURAL-HISTORY
KW - OPEN-LABEL
KW - MULTICENTER
KW - MANAGEMENT
KW - ASSOCIATION
KW - ANASTOMOSIS
KW - INFLIXIMAB
KW - PLEXITIS
U2 - 10.1111/apt.18040
DO - 10.1111/apt.18040
M3 - (Systematic) Review article
SN - 0269-2813
VL - 60
SP - 310
EP - 326
JO - Alimentary Pharmacology & Therapeutics
JF - Alimentary Pharmacology & Therapeutics
IS - 3
ER -