4478 Endoscopic prediction of early postsurgical recurrence in patients with crohn's disease.

Background/Aim: High relapse rate of re-stenosis at the site of intestinal anastomosis in postsurgical patients with Crohn's disease is reported from several study groups. These studies revealed that appearance of endoscopic changes at the site of anastomosis frequently preceded to production of typical symptoms. However, it is still unclear when endoscopic observation should be performed, or how we can detect risky patients of earlier recurrence of anastomotic re-stenosis. To find out the predictive markers for earlier recurrence, we have prospectively observed the sequential changes of endoscopic features appeared at the site of anastomosis, from immediately after surgery to recurrence of typical stenotic lesions. Patients/Methods: Twenty-nine patients with Crohn's disease who underwent intestinal/colonic resection in Asahikawa Medical College Hospital from 1990 to 1999 were subjected in this study. All the patients had ileocolonic or colo-colonic anastomosis, which were accessible by colonoscopy. Endoscopic observation and combined endoscopic retrograde ileography (ERIG) were performed at 1,6, and 12 months after surgery. One year after surgery, these observations were repeated at once a year. Results: At 1 month after surgery, 24.9% (7/29) patients already had small aphthous ulcer(s) at the site of anastomosis. These lesions were not disappeared, then incidence of relapsing these lesions were increased ( 6 months; 48.3% (14/29) 12 months; 65.5% (19/29)). Stenotic lesions due to multiple or longitudinal ulceration of anastomosis were detected from 2 years after surgery, in the patients of ulcer(+) at 12 months (31.6% (6/19)). However, no patients developed stenotic lesions within 5 years after surgery among 10 patients of ulcer (-) at 12 months. Significant statistical correlation in Logrank test was detected between ulcer (+) at 12 months and development of stenosis, or requirement of re-operation. Other factors such as disease duration, administration of 5-ASA, nocternal nutritional supprement with elemental diet, or methods of anastomosis did not correlate with postsurgical relapse rate in our patients. Conclusion: Developement of aphthous or small ulcer(s) within a year after surgery at the site of anastomosis is a risk factor of earlier re-stenosis or re-operation. Endoscopic evaluation of anastomotic areas at 12 months after surgery is necessary in management for postsurgical CD patients.