Background The Rutgeerts score (RS) is widely used to predict postoperative recurrence after ileocolonic resection for Crohn's disease (CD) based on the severity of lesions at the neoterminal ileum and anastomosis (RS i0-i4). However, the value of anastomotic ulcers remains controversial. Objectives Our aim was to establish a nomogram model incorporating ileal and anastomotic lesions separately to predict the long-term outcomes of CD after ileal or ileocolonic resection. Design A total of 136 patients with CD were included in this retrospective cohort study. Methods Consecutive CD patients who underwent ileal or ileocolonic resections with postoperative ileocolonoscopy evaluation within 1 year after the surgery were included. The primary endpoint was postoperative clinical relapse (CR). An endoscopic classification separating ileal and anastomotic lesions was applied (Ix for neoterminal ileum lesions; Ax for anastomotic lesions). A nomogram was constructed to predict CR. The performance of the model was evaluated by the receiver-operating characteristic (ROC) curve and decision curve analysis (DCA). Results CR was observed in 47.1% (n = 64) of patients within a median follow-up of 26.9 (interquartile range, 11.4-55.2) months. The risk of CR was significantly higher in patients with an RS ⩾ i2 assessed by the first postoperative endoscopy compared with patients with an RS ⩽ i1 (p < 0.001). Moreover, the cumulative rate of CR was significantly higher in patients with ileal lesions (I1-4) compared with patients without (I0) (p < 0.001). Besides, patients with anastomotic lesions (A1-3) had significantly higher rates of CR than patients without (A0) (p = 0.002). A nomogram, incorporating scores of postoperative ileal or anastomotic lesions, sex, L2-subtype and perianal disease, was established. The DCA analysis indicated that the nomogram had a higher benefit for CR, especially at the timeframe of 24-60 months after index endoscopy, compared to the traditional RS score. Conclusion A nomogram incorporating postoperative ileal and anastomotic lesions separately was developed to predict CR in CD patients, which may serve as a practical tool to identify high-risk patients who need timely postoperative intervention.

中文翻译：

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分别包含回肠和吻合口病变的列线图，用于预测回结肠切除术后克罗恩病的长期结果。

背景 Rutgeerts 评分 (RS) 广泛用于根据回肠新末端和吻合处病变的严重程度 (RS i0-i4) 预测克罗恩病 (CD) 回结肠切除术后复发。然而，吻合口溃疡的价值仍存在争议。目的 我们的目的是建立一个分别包含回肠和吻合口病变的列线图模型，以预测回肠或回结肠切除术后 CD 的长期结果。设计 本回顾性队列研究共纳入 136 名 CD 患者。方法纳入术后1年内连续接受回肠或回结肠切除术并进行术后回结肠镜评估的CD患者。主要终点是术后临床复发（CR）。应用内镜分类来区分回肠和吻合口病变（Ix 代表回肠新末端病变；Ax 代表吻合口病变）。构建列线图来预测 CR。通过受试者工作特征（ROC）曲线和决策曲线分析（DCA）评估模型的性能。结果 在中位随访 26.9 个月（四分位距，11.4-55.2）个月内，47.1%（n = 64）的患者观察到 CR。与 RS ⩽ i1 的患者相比，首次术后内镜检查评估 RS ⩾ i2 的患者 CR 风险显着更高 (p < 0.001)。此外，与无回肠病变的患者（I0）相比，有回肠病变的患者（I1-4）的累积 CR 率显着更高（p < 0.001）。此外，有吻合口病变的患者（A1-3）的 CR 率显着高于没有吻合口病变的患者（A0）（p = 0.002）。建立了列线图，其中包含术后回肠或吻合口病变、性别、L2 亚型和肛周疾病的评分。DCA 分析表明，与传统的 RS 评分相比，列线图对 CR 具有更高的益处，尤其是在指数内窥镜检查后 24-60 个月的时间范围内。结论 开发了一种分别包含术后回肠和吻合口病变的列线图来预测 CD 患者的 CR，这可以作为识别需要及时术后干预的高危患者的实用工具。