Predictive Value of the REMIND Endoscopic Score for Clinical Recurrence After Ileocolic Resection in Crohn's Disease

Abstract

Background: This study evaluates the REMIND score’s performance in predicting postoperative Crohn’s disease recurrence compared to the Rutgeerts score, which has the limitation of grouping anastomotic and neo-terminal ileal lesions together with equal prognostic value.
Methods: We conducted a monocentric, retrospective, evaluative study of patients operated for Crohn’s disease. All patients had a follow-up colonoscopy within one year of surgery. Clinical relapse was defined by the Crohn’s disease related symptoms or complications, such as intra-
abdominal collection or occlusion, or subsequent postoperative surgery. Data analysis was performed using SPSS.25.
Results: Eighty patients were included. Clinical recurrence-free survival was significantly shorter in patients with ileal lesions whatever their severity was I(1,2,3,4)A(x), compared with patients without ileal lesions I(0)A(x): p<0,001 and not significantly different between patients without
anastomotic lesions I(x)A(0) and patients with anastomotic lesions whatever their severity was I(x)A(1,2,3): p=0,2. However, patients with at least semicircumferential anastomotic ulcerations A(2,3) had more anastomotic occlusive complications than patients classified A0 or A1: A0 VS A2 p=0,01 A0 VS A3 p<0,001 A0 VS A1 p=0,9. The I(x) score, compared with the Rutgeerts and A(x) scores, had the best values in terms of discriminative capacity (Area under the curve= 0,83 VS 0,73 VS 0,61), monotonicity (linearity test χ2 of 26,77 VS 12,36 VS 3,89), and homogeneity (likelihood ratio χ2 of 33,91 vs 18,45 VS 5,49).
Conclusion: The I(x) score outperformed both the Rutgeerts and A(x) scores in predicting postoperative recurrence. Consequently, evaluating ileal and anastomotic lesions separately provides a more accurate assessment of endoscopic recurrence