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MESENTERY HYPERTROPHY TO IDENTIFY MICROSCOPIC CLEAN ILEAL SECTION AND REDUCE POSTOPERATIVE ENDOSCOPIC RECURRENCE IN ILEOCOLIC CROHN'S DISEASE
Jiaxin Zou
*, xijian zhang, Chao Wang, Xinzhe Zhao, Zhen He, Xiang Gao, Min Zhi, Xiao-Jian Wu, Jia Ke
Sun Yat-sen University Sixth Affiliated Hospital, Guangzhou, Guangdong, China
Background: Microscopic clean margin is associated with reduced endoscopic recurrence after bowel resection for ileocolic Crohn's disease (CD). We aimed to investigate whether the mesenteric hypertrophy could help indicate microscopic inflammation by naked eye assessment and reduce endoscopic recurrence after ileocolic resection.
Methods: Circumferential HE slides were prospectively obtained from surgical ileal specimens. Microscopic abnormalities within each bowel layer and circumferential mesenteric coverage rate (MCR) were examined under microscopy. Retrospective surgical cohorts were established to compare endoscopic recurrence rate after proximal division by conventional 2cm width or mesenteric guidance (Mes-G). Modified Rutgeerts and REMIND scores were used to assess endoscopic recurrence from neoileum and anastomosis line separately within 6 and 12 months.
Results: Under microscopy, MCR was linearly correlated with CD inflammation within whole-depth and each layer of the bowel wall, even in the slides with normal mucosa. In Mes-G resection group, post-operative endoscopic recurrence at 6 and 12 months, and the progression rate were significantly lower by classic and modified Rutgeerts scores. Reduced endoscopic and clinical recurrence was independently impacted by messenteric guidance by multivariate regression. Using REMIND score, reduced recurrence in Mes-G group was caused by the alleviated flares in neoileum segment, rather than the anastomosis site.
Conclusions: The mesenteric coverage could be used to indicate the level of microscopic CD inflammation, and mesenteric guidance resection could help reduce postoperative endoscopic recurrence for ileocolic CD patients.
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