Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 Mar 14;16(3):490-499.
doi: 10.1093/ecco-jcc/jjab163.

The Relationship Between Endoscopic and Clinical Recurrence in Postoperative Crohn's Disease: A Systematic Review and Meta-analysis

Alessandro Ble  1 , Cecilia Renzulli  1 , Fabio Cenci  1 , Maria Grimaldi  1 , Michelangelo Barone  1 , Rocio Sedano  2   3 , Joshua Chang  2 , Tran M Nguyen  2 , Malcolm Hogan  2 , Guangyong Zou  2   4 , John K MacDonald  2 , Christopher Ma  2   5 , William J Sandborn  2   6 , Brian G Feagan  2   3   4 , Emilio Merlo Pich  1 , Vipul Jairath  2   3   4
Affiliations
Meta-Analysis

The Relationship Between Endoscopic and Clinical Recurrence in Postoperative Crohn's Disease: A Systematic Review and Meta-analysis

Alessandro Ble et al. J Crohns Colitis. .

Abstract

Background and aims: We aimed to quantify the magnitude of the association between endoscopic recurrence and clinical recurrence [symptom relapse] in patients with postoperative Crohn's disease.

Methods: Databases were searched to October 2, 2020, for randomised controlled trials [RCTs] and cohort studies of adult patients with Crohn's disease with ileocolonic resection and anastomosis. Summary effect estimates for the association between clinical recurrence and endoscopic recurrence were quantified by risk ratios [RR] and 95% confidence intervals [95% CI]. Mixed-effects meta-regression evaluated the role of confounders. Spearman correlation coefficients were calculated to assess the relationship between these outcomes as endpoints in RCTs. An exploratory mixed-effects meta-regression model with the logit of the rate of clinical recurrence as the outcome and the rate of endoscopic recurrence as a predictor was also evaluated.

Results: In all, 37 studies [N = 4053] were included. For eight RCTs with available data, the RR for clinical recurrence for patients who experienced endoscopic recurrence was 10.77 [95% CI 4.08 to 28.40; GRADE moderate certainty evidence]; the corresponding estimate from 11 cohort studies was 21.33 [95% CI 9.55 to 47.66; GRADE low certainty evidence]. A single cohort study showed a linear relationship between Rutgeerts score and clinical recurrence risk. There was a strong correlation between endoscopic recurrence and clinical recurrence treatment effect estimates as trial outcomes [weighted Spearman correlation coefficient 0.51].

Conclusions: The associations between endoscopic recurrence and subsequent clinical recurrence lend support to the choice of endoscopic recurrence to monitor postoperative disease activity and as a primary endpoint in clinical trials of postoperative Crohn's disease.

Keywords: Postoperative Crohn’s disease; clinical recurrence; endoscopic recurrence.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
PRISMA flow diagram summarising the study selection process and results.
Figure 2.
Figure 2.
Pooled risk ratio [RR].
Figure 3.
Figure 3.
Pooled risk ratio [RR]—sensitivity analysis.
Figure 4.
Figure 4.
Meta-analytical scatter plot of the rate of endoscopic recurrence [x-axis] vs the rate of clinical recurrence [y-axis].
See this image and copyright information in PMC

References

    1. Regueiro M, Velayos F, Greer JB, et al. American Gastroenterological Association Institute Technical Review on the Management of Crohn’s Disease After Surgical Resection. Gastroenterology 2017;152:277–95.e3. - PubMed
    1. Nguyen GC, Loftus EV Jr, Hirano I, Falck-Ytter Y, Singh S, Sultan S; AGA Institute Clinical Guidelines Committee . American Gastroenterological Association Institute Guideline on the Management of Crohn’s Disease After Surgical Resection. Gastroenterology 2017;152:271–5. - PubMed
    1. Frolkis AD, Dykeman J, Negrón ME, et al. Risk of surgery for inflammatory bowel diseases has decreased over time: a systematic review and meta-analysis of population-based studies. Gastroenterology 2013;145:996–1006. - PubMed
    1. Lee YW, Lee KM, Chung WC, Paik CN, Sung HJ, Oh YS. Clinical and endoscopic recurrence after surgical resection in patients with Crohn’s disease. Intest Res 2014;12:117–23. - PMC - PubMed
    1. Rutgeerts P, Geboes K, Vantrappen G, Beyls J, Kerremans R, Hiele M. Predictability of the postoperative course of Crohn’s disease. Gastroenterology 1990;99:956–63. - PubMed