Prognostic Significance of Different Endoscopic Scores in Post-Operative Crohn's Disease and their Role in Patients with Low-Risk Features.

introductionEndoscopic assessment, routinely performed using the Rutgeerts score (RS), offers prognostic information for postoperative Crohn's disease (CD) patients. The clinical relevance of anastomotic lesions (AL), however, remains debated. Additional proposed scoring systems include the POCER index (PI) and the UEDA et al. score (US), which also characterize anastomotic and peri-anastomotic disease features. Our retrospective study aims to evaluate the predictive value of the PI and the US in a real-life cohort.

methodsConsecutive patients with CD undergoing ileo-colonic resection with subsequent first endoscopic evaluation within 6-12 months after surgery were enrolled. Endoscopic recurrence (ER) was assessed by RS, PI and US. Clinical recurrence (CR) was assessed at 24 ± 3 months. A second endoscopy at 24 ± 3 months was available for some patients.

resultsA total of 177 patients were included. Regarding CR prediction, RS ≥ i2 showed an AUROC of 0.74 (sensitivity 82.7%, specificity 56.9%); PI ≥ 2 an AUROC of 0.61 (sensitivity 31%, specificity 82.5%); US ≥ intermediate an AUROC of 0.67 (sensitivity 50%, specificity 74.6%). In patients without ileal lesions at 6-12 months, RS ≥ i2 showed an AUROC of 0.68 (sensitivity 58.3%, specificity 75.8%), PI an AUROC of 0.67 (sensitivity 25%, specificity 92.6%) and the US ≥ intermediate an AUROC of 0.63 (sensitivity 16.7%, specificity 93.4%) for predicting CR. In the sub-cohort of patients with RS < i3 at 6-12 months, the PI showed an AUROC of 0.65 (sensitivity 21.4%, specificity 87.3%), while the US showed an AUROC of 0.53 (sensitivity 14.3%, specificity 82.6%) for CR.

conclusionGrading AL seems to improve the prognostic value of early endoscopic assessment in predicting postoperative clinical recurrence. Future prospective studies are required to validate these findings. Graphical Abstract available for this article. Postoperative recurrence is a prevalent issue in Crohn's disease, affecting patients' quality of life. The Rutgeerts score serves as the standard scoring system for assessing the presence and severity of endoscopic activity after surgery; however, it is often inaccurate, particularly in cases of mild inflammation or when inflammation is confined to surgical connection between two parts of the bowel (the anastomosis). This study investigated two alternative scoring systems: the POCER index and the score developed by Ueda et al. These tools offer a more comprehensive evaluation of the anastomotic area and have proven useful in predicting postoperative recurrence within 2 years post-surgery, especially when inflammation is restricted to the anastomosis. Integrating these newer scoring systems into routine clinical practice may facilitate earlier identification of patients at higher risk of recurrence, thereby aiding in the development of more personalized treatment strategies.