A team from Paris, France, determined whether the presence of severe endoscopic lesions (SELs) in Crohn's disease might predict a higher risk of colectomy and penetrating complications.
All patients with active ileocolonic Crohn's disease, who had colonoscopies between 1990 and 1996 at the Saint-Louis Hospital, were included in the study.
SELs were defined as extensive and deep ulcerations covering more than 10% of the mucosal area of at least one segment of the colon.
Among the 102 patients included, 53 had SELs at index colonoscopy.
During the follow-up (median, 52 months), 37 patients underwent colonic resection.
Probabilities of colectomy at 1, 3, and 8 years were 20%, 26%, and 42%.
| Presence of severe endoscopic lesions increased colectomy risk more than 5-times.
| American Journal of Gastroenterology |
Risk of colectomy was independently affected by the presence of SELs at index colonoscopy (relative risk [RR] = 5.43). It was also affected by a Crohn's Disease Activity Index level greater than 288 (RR = 2.21), and the absence of immunosuppressive therapy during the follow-up (RR = 2.44).
Probabilities of colectomy in patients with and without SELs were, respectively, 31% and 6% at 1 year, 42% and 8% at 3 years, and 62% and 18% at 8 years.
The researchers performed a second analysis, excluding the 14 patients operated on within the 3 months after the index colonoscopy.
They found that the presence of SELs remained the only significant factor predictive of colectomy (RR = 6.72).
It was found that all 6 patients with penetrating complications during the follow-up had SELs at index colonoscopy.
Dr Matthieu Allez concluded on behalf of his group, "Patients with Crohn's disease exhibiting deep and extensive ulcerations at colonoscopy have a more aggressive clinical course, with an increased rate of penetrating complications and surgery."