Evaluation of pathological findings in predicting postoperative endoscopic recurrence in Crohn's disease: A retrospective cohort study.

Background: Crohn's disease (CD) patients with intestinal involvement often require surgical intervention due to resistance to medical therapy. Postoperative recurrence remains a significant challenge, with the Rutgeerts score commonly used to predict endoscopic recurrence.

Aim: To evaluate the relationship between microscopic and macroscopic pathological findings in resected intestinal specimens and the Rutgeerts score to predict endoscopic recurrence in CD patients.

Methods: This retrospective cohort study included 32 patients over 18 years of age with intestinal CD who underwent surgery at General Surgery Clinic of Ankara Bilkent City Hospital between November 2019 and October 2023. Resection specimens were histopathologically re-examined, and postoperative colonoscopy reports were classified according to the Rutgeerts score. The association between pathological findings and endoscopic recurrence was analyzed statistically.

Results: No significant association was found between macroscopic findings and Rutgeerts scores or endoscopic recurrence (P > 0.05). However, the presence and severity of neutrophilic cryptitis (P = 0.035) and crypt abscesses (P = 0.010) in microscopic findings were significantly associated with higher Rutgeerts scores, indicating a parallel increase with endoscopic recurrence. Other microscopic findings showed no significant correlation with Rutgeerts scores or endoscopic recurrence (P > 0.05).

Conclusion: The presence of neutrophilic cryptitis and crypt abscesses in resected intestinal specimens of CD patients increases the likelihood of endoscopic recurrence. Early postoperative medical treatment and close endoscopic follow-up may benefit high-risk patients to prevent recurrence, with treatment decisions made by a weekly multidisciplinary council involving General Surgery, Gastroenterology, and Radiology.