Karabulut I, Çetinkaya E, Turhan N, Yurekli OT, Tez M. Evaluation of pathological findings in predicting postoperative endoscopic recurrence in Crohn’s disease: A retrospective cohort study. World J Gastrointest Surg 2025; 17(9): 110125 [DOI: 10.4240/wjgs.v17.i9.110125]
Corresponding Author of This Article
Mesut Tez, MD, Department of Surgery, University of Health Sciences, Ankara City Hospital, No. 1 Bilkent Street, District of Universities, Ankara 06800, Türkiye. mesuttez@yahoo.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Işıl Karabulut, Department of Surgery, Ankara Bilkent City Hospital, Ankara 06800, Türkiye
Erdinç Çetinkaya, Department of General Surgery, University of Health Sciences, Ankara Bilkent City Hospitale
Erdinç Çetinkaya, Department of Medical and Surgical Research, Institute of Health Sciences, Hacettepe University, Ankara 06100, Turkey
Nesrin Turhan, Department of Pathology, University of Health Sciences, Ankara City Hospital, Ankara 06800, Türkiye
Oyku Tayfur Yurekli, Department of Gastroenterology, School of Medicine, Yıldırım Beyazıt University, Ankara 06800, Türkiye
Mesut Tez, Department of Surgery, University of Health Sciences, Ankara City Hospital, Ankara 06800, Türkiye
Author contributions: Karabulut I conceptualized the study, collected data, and drafted the manuscript; Çetinkaya E assisted in data collection, performed statistical analysis, and reviewed the manuscript; Turhan N conducted histopathological re-evaluation of resection specimens and contributed to the interpretation of pathological findings; Yurekli OT provided expertise in gastroenterology, contributed to data interpretation, and revised the manuscript for intellectual content; Tez M supervised the study, contributed to the study design, coordinated the multidisciplinary council, and finalized the manuscript as the corresponding author. All authors have read and approved the final version of the manuscript.
Institutional review board statement: This study was approved by the Ethics Committee of Ankara Bilkent City Hospital, No. TABED 2-24-219.
Informed consent statement: Written informed consent was obtained from all participants.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The datasets generated and analyzed during the current study are available from the corresponding author, Mesut Tez, upon reasonable request. Access to the data will be subject to approval by the Ethics Committee of Ankara Bilkent City Hospital to ensure compliance with privacy regulations and institutional policies. De-identified data may be shared for research purposes, provided the request aligns with the study’s ethical approvals and data protection guidelines.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mesut Tez, MD, Department of Surgery, University of Health Sciences, Ankara City Hospital, No. 1 Bilkent Street, District of Universities, Ankara 06800, Türkiye. mesuttez@yahoo.com
Received: May 30, 2025 Revised: June 12, 2025 Accepted: July 17, 2025 Published online: September 27, 2025 Processing time: 117 Days and 19.6 Hours
Abstract
BACKGROUND
Crohn’s disease (CD) patients with intestinal involvement often require surgical intervention due to resistance to medical therapy. Postoperative recurrence remains a significant challenge, with the Rutgeerts score commonly used to predict endoscopic recurrence.
AIM
To evaluate the relationship between microscopic and macroscopic pathological findings in resected intestinal specimens and the Rutgeerts score to predict endoscopic recurrence in CD patients.
METHODS
This retrospective cohort study included 32 patients over 18 years of age with intestinal CD who underwent surgery at General Surgery Clinic of Ankara Bilkent City Hospital between November 2019 and October 2023. Resection specimens were histopathologically re-examined, and postoperative colonoscopy reports were classified according to the Rutgeerts score. The association between pathological findings and endoscopic recurrence was analyzed statistically.
RESULTS
No significant association was found between macroscopic findings and Rutgeerts scores or endoscopic recurrence (P > 0.05). However, the presence and severity of neutrophilic cryptitis (P = 0.035) and crypt abscesses (P = 0.010) in microscopic findings were significantly associated with higher Rutgeerts scores, indicating a parallel increase with endoscopic recurrence. Other microscopic findings showed no significant correlation with Rutgeerts scores or endoscopic recurrence (P > 0.05).
CONCLUSION
The presence of neutrophilic cryptitis and crypt abscesses in resected intestinal specimens of CD patients increases the likelihood of endoscopic recurrence. Early postoperative medical treatment and close endoscopic follow-up may benefit high-risk patients to prevent recurrence, with treatment decisions made by a weekly multidisciplinary council involving General Surgery, Gastroenterology, and Radiology.
Core Tip: This study highlights the predictive role of histological findings in postoperative Crohn’s disease management. Specifically, neutrophilic cryptitis and crypt abscesses in resected specimens are significantly associated with endoscopic recurrence, as measured by the Rutgeerts score. These findings can guide clinicians in identifying high-risk Crohn’s disease patients for early intervention and intensified endoscopic monitoring to mitigate recurrence risks, with decisions supported by a weekly multidisciplinary council.
