Abstract
Introduction
There is debate over the impact of residual microscopic disease after ileocecal resection
in Crohn's disease (CD) to predict recurrence. We conducted a meta-analysis to evaluate
the impact of positive histological margins and plexitis after ileocecal resection
on the risk of postoperative recurrence.
Methods
Using a systematic search, we identified. 30 studies evaluating the impact of inflammatory
margins on CD recurrence. The primary outcome was the postoperative clinical recurrence
and secondary outcomes were surgical, and endoscopic recurrence. We performed random-effects
meta-analysis and estimated odds ratio (OR) and 95% CIs.
Results
Thirty studies were analyzed, seven focused on myenteric plexitis, six on submucosal
plexitis and twenty-three on positive margins. Inflammatory margins were associated
with a higher rate of clinical and surgical recurrences: respectively 14 studies -
OR 2.38; 95% CI, 1.54 - 3.68- I2 = 68.2%, Q test-p = 0.0003 and 8 studies - OR, 1.52; 95% CI, 1.07–2.16 - I2 =0%; Q test-p = 0.43. The presence of myenteric plexitis was associated with a higher rate of clinical
recurrence (4 studies- OR, 1.60; 95%CI, 1.12–2.29; I2= 0%, Q-test-p = 0.61), and of endoscopic recurrence (4 studies - OR, 4.25; 95%CI; 2.06–8.76; I2=
0%, Q test-p = 0.97). Submucosal plexitis was not associated with an increased risk of endoscopic
recurrence (4 studies - OR, 0.94; 95%CI; 0.58–1.52; I2= 0%, Q test-p = 0.79).
Conclusion
Inflammatory margins and/or plexitis were associated with postoperative recurrence
after ileocecal resection for CD. These elements should be taken into account in future
algorithm for prevention of postoperative recurrence.
Keywords
Abbreviations:
CD (Crohn's disease), OR (odds ratio), RR (relative risk)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 17, 2023
Accepted:
December 23,
2022
Received:
July 27,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
