• Crohn's disease
• mesentery
• microbiome
• postoperative recurrence
• surgery

• Humans
• Crohn Disease/surgery
• Crohn Disease/pathology
• Colon/surgery
• Colon/pathology
• Anastomosis, Surgical/adverse effects
• Anastomosis, Surgical/methods
• Ileum/surgery
• Ileum/pathology
• Retrospective Studies
• Risk Factors
• Recurrence

• Crohn’s disease
• Ileocecal CD
• pharmacotherapy
• postoperative reccurence
• surgery

• Humans
• Crohn Disease/drug therapy
• Crohn Disease/surgery
• Infliximab/therapeutic use
• Treatment Outcome
• Ileum/surgery
• Immunologic Factors/therapeutic use
• Postoperative Complications/etiology
• Postoperative Complications/prevention & control
• Postoperative Complications/drug therapy
• Retrospective Studies

• Crohn’s disease
• composite outcomes
• observational studies

• Crohn’s disease
• Ileal margin
• Neuropeptides
• Plexitis
• Postoperative recurrence

• Crohn Disease/complications
• Crohn Disease/surgery
• Humans
• Ileum/surgery
• Margins of Excision
• Neoplasm Recurrence, Local/complications
• Neuropeptides
• Prognosis
• Recurrence
• Retrospective Studies

• Crohn’s disease
• Enteric nervous system
• inflammation
• inflammatory bowel disease
• neuro-immune
• neuroprotection
• plexitis
• ulcerative colitis

• Endoscopy
• inflammatory bowel disease [IBD]
• pathology
• reporting
• surgery

• Histology
• Ileocecal Resection
• Inflammation
• Pathology

• IBD Surgery
• Outcome
• Prognostic Factor
• REMIND Trial

Objectives: To assess the predictive values of myenteric and submucosal plexitis for postoperative endoscopic recurrence of Crohn's disease (CD). Methods: A retrospective study of CD patients who underwent intestinal resection between 1995 and 2013 in the Department of Surgery 2, Tokyo Women's Medical University was performed. Proximal resection margins were analyzed and plexitis was evaluated by counting the number of inflammatory cells in myenteric and submucosal plexuses. The sizes of the most severely inflamed ganglion (MIG) were measured. Multiple regression analysis was used to identify independent risk factors for postoperative endoscopic recurrence. Results: Of the 51 included patients, 40 patients underwent colonoscopy after surgery. Endoscopic recurrence was observed in 21 patients (52.5%). Mean duration (±standard deviation) from surgery to recurrence was 49.7±34.7 months. Endoscopic recurrence rates at 1, 3, and 5 years were 5.0%, 24.1%, and 45.1%, respectively. Submucosal plexitis and myenteric plexitis were observed in 36 (90.0%) and 37 patients (92.5%), respectively. On multivariate analysis, initial intestinal resection, rate of plexitis <50%, size of the MIG in the myenteric plexus ≥867 μm², and total number of inflammatory cells in the submucosal plexus ≥8 were independent risk factors for postoperative endoscopic recurrence. Conclusions: Pathological findings of proximal resection margins, especially submucosal plexitis and large sizes of myenteric plexus, are predictive of postoperative endoscopic recurrence in CD.

• Crohn's disease
• myenteric plexitis
• postoperative recurrence
• risk factor
• submucosal plexitis

• Crohn's disease
• enteric glial cells
• postoperative recurrence
• substance P
• vasoactive intestinal peptide

Intestinal resection for Crohn’s disease is not curative and postoperative recurrence rates remain high. Early detection of indices associated with recurrence and risk stratification are fundamental for the postoperative management of patients. Early endoscopy at 6-12 months is the “gold standard” procedure, whereas other modalities such as fecal calprotectin and imaging techniques can contribute to the diagnosis of recurrence. The purpose of this review is to summarize current data regarding risk factors correlated with postoperative relapse. Smoking is a well-established, modifiable risk factor. There are sufficient data that correlate penetrating disease, perianal involvement, extensive resections, prior surgery, histological features (plexitis and granulomas), and improper management after resection with high rates for recurrence. The literature provides conflicting data for other possible predictors, such as age, sex, family history of inflammatory bowel disease, location of disease, strictureplasties, blood transfusions, and postoperative complications, necessitating further evidence. On the other hand, surgical factors such as anastomotic configuration, open or laparoscopic approach, and microscopic disease at specimen margins when macroscopic disease is resected, seem not to be related with an increased risk of recurrence. Further recognition of histological features as well as gene-related factors are promising fields for research.

• Crohn’s disease
• postoperative recurrence
• recurrence risk factors

To evaluate the presence of submucosal and myenteric plexitis and its role in predicting postoperative recurrence.

Data from all patients who underwent Crohn’s disease (CD)-related resection at the University of Szeged, Hungary between 2004 and 2014 were analyzed retrospectively. Demographic data, smoking habits, previous resection, treatment before and after surgery, resection margins, neural fiber hyperplasia, submucosal and myenteric plexitis were evaluated as possible predictors of postoperative recurrence. Histological samples were analyzed blinded to the postoperative outcome and the clinical history of the patient. Plexitis was evaluated based on the appearance of the most severely inflamed ganglion or nerve bundle. Patients underwent regular follow-up with colonoscopy after surgery. Postoperative recurrence was defined on the basis of endoscopic and clinical findings, and/or the need for additional surgical resection.

One hundred and four patients were enrolled in the study. Ileocecal, colonic, and small bowel resection were performed in 73.1%, 22.1% and 4.8% of the cases, respectively. Mean disease duration at the time of surgery was 6.25 years. Twenty-six patients underwent previous CD-related surgery. Forty-three point two percent of the patients were on 5-aminosalicylate, 20% on corticosteroid, 68.3% on immunomodulant, and 4% on anti-tumor necrosis factor-alpha postoperative treatment. Postoperative recurrence occurred in 61.5% of the patients; of them 39.1% had surgical recurrence. 92.2% of the recurrences developed within the first five years after the index surgery. Mean disease duration for endoscopic relapse was 2.19 years. The severity of submucosal plexitis was a predictor of the need for second surgery (OR = 1.267, 95%CI: 1.000-1.606, P = 0.050). Female gender (OR = 2.21, 95%CI: 0.98-5.00, P = 0.056), stricturing disease behavior (OR = 3.584, 95%CI: 1.344-9.559, P = 0.011), and isolated ileal localization (OR = 2.671, 95%CI: 1.033-6.910, P = 0.043) were also predictors of postoperative recurrence. No association was revealed between postoperative recurrence and smoking status, postoperative prophylactic treatment and the presence of myenteric plexitis and relapse.

The presence of severe submucosal plexitis with lymphocytes in the proximal resection margin is more likely to result in postoperative relapse in CD.

• Submucosal plexitis
• Postoperative recurrence
• Crohn’s disease
• Stricturing disease behavior
• Isolated ileal disease

• Endoscopy
• pathology
• surgery

• Crohn's disease
• Plexitis
• Postoperative recurrence
• Risk factors

AIM: To investigate whether an endoscopy-based management could prevent the long-term risk of postoperative recurrence.

METHODS: From the pathology department database, we retrospectively retrieved the data of all the patients operated on for Crohn’s disease (CD) in our center (1986-2015). Endoscopy-based management was defined as systematic postoperative colonoscopy (median time after surgery = 9.5 mo) in patients with no clinical postoperative recurrence at the time of endoscopy.

RESULTS: From 205 patients who underwent surgery, 161 patients (follow-up > 6 mo) were included. Endoscopic postoperative recurrence occurred in 67.6%, 79.7%, and 95.5% of the patients, respectively 5, 10 and 20 years after surgery. The rate of clinical postoperative recurrence was 61.4%, 75.9%, and 92.5% at 5, 10 and 20 years, respectively. The rate of surgical postoperative recurrence was 19.0%, 38.9% and 64.7%, respectively, 5, 10 and 20 years after surgery. In multivariate analysis, previous intestinal resection, prior exposure to anti-TNF therapy before surgery, and fistulizing phenotype (B3) were postoperative risk factors. Previous perianal abscess/fistula (other perianal lesions excluded), were predictive of only symptomatic recurrence. In multivariate analysis, an endoscopy-based management (n = 49/161) prevented clinical (HR = 0.4, 95%CI: 0.25-0.66, P < 0.001) and surgical postoperative recurrence (HR = 0.30, 95%CI: 0.13-0.70, P = 0.006).

CONCLUSION: Endoscopy-based management should be recommended in all CD patients within the first year after surgery as it highly decreases the long-term risk of clinical recurrence and reoperation.

• Crohn’s disease
• Postoperative recurrence
• Endoscopy
• Prevalence
• Risk factors

• Adult
• Chi-Square Distribution
• Colectomy/adverse effects
• Colonoscopy
• Crohn Disease/pathology
• Crohn Disease/surgery
• Disease-Free Survival
• Female
• France
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Multivariate Analysis
• Predictive Value of Tests
• Proportional Hazards Models
• Recurrence
• Reoperation
• Retrospective Studies
• Risk Factors
• Time Factors
• Treatment Outcome
• Young Adult

• Crohn's disease
• ileocaecal resection
• myenteric plexitis
• pathology
• recurrence prediction
• surgical recurrence

• colon motility
• enteric neurons
• inflammatory bowel disease
• intestinal inflammation
• mesenchymal stem cells

Endoscopic and clinical recurrence of Crohn’s disease (CD) is a common occurrence after surgical resection. Smokers, those with perforating disease, and those with myenteric plexitis are all at higher risk of recurrence. A number of medical therapies have been shown to reduce this risk in clinical trials. Metronidazole, thiopurines and anti-tumour necrosis factors (TNFs) are all effective in reducing the risk of endoscopic or clinical recurrence of CD. Since these are preventative agents, the benefits of prophylaxis need to be weighed-against the risk of adverse events from, and costs of, therapy. Patients who are high risk for post-operative recurrence should be considered for early medical prophylaxis with an anti-TNF. Patients who have few to no risk factors are likely best served by a three-month course of antibiotics followed by tailored therapy based on endoscopy at one year. Clinical recurrence rates are variable, and methods to stratify patients into high and low risk populations combined with prophylaxis tailored to endoscopic recurrence would be an effective strategy in treating these patients.

• Inflammatory bowel disease
• Crohn’s disease
• Postoperative recurrence
• Medical treatment
• Biologics

• Anti-Bacterial Agents/economics
• Anti-Bacterial Agents/therapeutic use
• Anti-Inflammatory Agents/economics
• Anti-Inflammatory Agents/therapeutic use
• Cost-Benefit Analysis
• Crohn Disease/diagnosis
• Crohn Disease/economics
• Crohn Disease/surgery
• Digestive System Surgical Procedures/adverse effects
• Digestive System Surgical Procedures/economics
• Drug Costs
• Endoscopy, Gastrointestinal
• Gastrointestinal Agents/economics
• Gastrointestinal Agents/therapeutic use
• Humans
• Patient Selection
• Predictive Value of Tests
• Risk Assessment
• Risk Factors
• Secondary Prevention
• Time Factors
• Treatment Outcome

Endoscopy plays an important role in the diagnosis and management of inflammatory bowel disease (IBD). It is useful to exclude other aetiologies, differentiate between ulcerative colitis (UC) and Crohn’s disease (CD), and define the extent and activity of inflammation. Ileocolonoscopy is used for monitoring of the disease, which in turn helps to optimize the management. It plays a key role in the surveillance of UC for dysplasia or neoplasia and assessment of post operative CD. Capsule endoscopy and double balloon enteroscopy are increasingly used in patients with CD. Therapeutic applications relate to stricture dilatation and dysplasia resection. The endoscopist’s role is vital in the overall management of IBD.

• Colonoscopy
• Oesophagogastroduodenoscopy
• Capsule endoscopy
• Enteroscopy
• Ulcerative colitis
• Crohn’s disease
• Dysplasia
• Endoscopist

• Crohn Disease/epidemiology
• Crohn Disease/genetics
• Crohn Disease/microbiology
• Crohn Disease/pathology
• Crohn Disease/surgery
• Frameshift Mutation
• Genetic Predisposition to Disease/genetics
• Homeostasis
• Humans
• Ileitis/epidemiology
• Ileitis/genetics
• Ileitis/pathology
• Ileitis/surgery
• Ileum/microbiology
• Ileum/pathology
• Laparoscopy
• Life Style
• Nod2 Signaling Adaptor Protein/genetics
• Risk Factors
• Secondary Prevention
• Smoking/epidemiology