Decreased Lymphatic Vessel Density Is Associated With Postoperative Endoscopic Recurrence in Crohn%26apos;s Disease

作者：Rahier Jean Francois^*; Dubuquoy Laurent; Colombel Jean Frederic; Jouret Mourin Anne; Delos Monique; Ferrante Marc; Sokol Harry; De Hertogh Gert; Salleron Julia; Geboes Karel; Desreumaux Pierre

来源：Inflammatory Bowel Diseases, 2013, 19(10): 2084-2090.

DOI：10.1097/MIB.0b013e3182971cec

• Crohn%26apos
• s disease
• lymphatic vessel
• endoscopic recurrence

Background:Increased lymphatic vessel (LV) density has been found in uninflamed intestinal wall of patients with Crohn%26apos;s disease (CD). The goal of the study was to search for an association between LV density in the proximal ileal resection margin at the time of surgery and endoscopic recurrence.Methods:Ileocolonic resection specimens were obtained from 28 CD patients and 10 control subjects. The ileal proximal uninflamed section was used for the histological quantification of LV using immunohistochemistry with D2-40 antibody in the mucosa and submucosa. Quantification of LV was performed in 8 consecutive fields and was blinded to recurrence score. Patients were divided into 2 groups based on the presence (Rutgeerts score, i3/i4) (R+) or absence (Rutgeerts score, i0/i1) (R-) of endoscopic recurrence 1 year after the surgery. All patients were free of immunomodulators or biologics between surgery and postoperative endoscopy.Results:Median LV density was lower in control subjects than in CD patients in the mucosa (4.5%; interquartile range [IQR], 3.6-5.3 versus 5.9%; IQR, 4.2-8.5; P = 0.04) and submucosa (2.4%; IQR, 1.9-3.6 versus 5.7%; IQR, 4.3-6.9; P %26lt; 0.01). R- patients had a higher LV density in the proximal resection margin at surgery than R+ patients, both in the mucosa (8.5%; IQR, 6.5-10.3 versus 4.4%; IQR, 3.1-6.1; P %26lt; 0.01) and in the submucosa (6.3%; IQR, 5.5-9.3 versus 5.3%; IQR, 3.4-5.9; P = 0.03). Mucosal LV density greater than 7% predicted the absence of endoscopic recurrence at 1 year, with a sensitivity of 81% and a specificity of 75%.Conclusions:Decreased LV density is associated with high risk of endoscopic recurrence after surgery. Therapies that improve lymphatic flow in the gut may reduce the incidence of endoscopic recurrence.

• 出版日期2013-9