Postoperative diagnostic revision for Crohn disease after subtotal colectomy for inflammatory bowel disease
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ORIGINAL ARTICLE
Postoperative diagnostic revision for Crohn disease after subtotal colectomy for inflammatory bowel disease Hélène Hermand 1 & Jérémie H. Lefèvre 1 & Conor Shields 1,2 & Najim Chafai 1 & Clotilde Debove 1 & Laurent Beaugerie 3 & Magali Svrcek 4 & Yann Parc 1 & for the Saint-Antoine IBD Network Accepted: 9 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Subtotal colectomy (STC) is performed for severe acute and refractory colitis. The diagnosis can be difficult even after the surgery when colectomy specimen has overlapping features of ulcerative colitis (UC) and Crohn’s disease (CD). The aim of this study was to evaluate the rate of postoperative diagnostic revision to CD after surgery and determine predictor factors. Methods Retrospective study of 110 patients who underwent STC (2005–2018). Results Preoperative diagnosis comprised UC = 80 (73%), CD = 11 (10%), and unclassified colitis (IBDU = 19, 17%). Initial diagnosis of IBDU and UC was modified to CD in 6 patients (6%) after STC. The final diagnosis after the follow-up of 10 ± 6 years switched from CD for 8 patients (9%). The multivariate analysis showed that patients with a colitis evolving for less than 10 years and initial diagnosis of IBDU were the two independent factors associated with an increased risk of diagnosis change to CD (p = 0.03; p = 0.016). At the end of the follow-up, 15 patients (14%) had a definitive stoma. Conclusions In patients with IBD, attention must be paid to determine the right restorative strategy to patients with an evolution of the disease less than 10 years or with IBDU who are more at risk to have a diagnosis change to CD after STC. Keywords Colitis . Subtotal colectomy . Crohn’s colitis . Ulcerative colitis
Introduction The spectrum of inflammatory bowel disease (IBD) encompasses both Crohn’s disease (CD) and ulcerative colitis (UC). While UC affects solely the rectum and the colon, CD may be found throughout the gastrointestinal tract, including the Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00384-020-03783-9) contains supplementary material, which is available to authorized users. * Jérémie H. Lefèvre [email protected] 1
Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Sorbonne Université, F-75012 Paris, France
2
Mater Misericordia University Hospital, Dublin, Ireland
3
Department of Gastroenterology, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, AP-HP Hôpital Saint-Antoine, Sorbonne Université, Paris, France
4
Department of Pathology, Assistance Publique Hôpitaux de Paris, Hôpital Saint Antoine, Sorbonne Université, Paris, France
rectum and colon in the case of CD [1–5]. In some cases, patients with chronic colitis clearly have IBD based on the clinical history but macroscopy and/or endoscopic biopsies show no definitive features of UC or CD; the term unclassified colitis (IBDU) is thus used for these patients. [6] Postoperative examinations of resections of such
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