Number of Strictures in Crohn's Disease Predict Obstruction Recurrence

The number of strictures and strictureplasties in Crohn's disease (CD) patients who undergo surgery for such strictures could predict the likelihood of recurrent obstruction, according to a new study.

Researchers at the Mount Sinai Medical Center (New York, NY, USA) reviewed data on 88 patients that underwent 339 strictureplasties between 1984 and 2004. The researchers used reoperation on the strictures as a marker for recurrence, and reoperation rates were compared based on the strictures and strictureplasties using Kaplan-Meier curves. Cox regression analyses were used to evaluate the relationship between both strictures and strictureplasties and recurrence, after adjusting for potential confounders.

The researchers found that five-year actuarial reoperation rates were 14% in patients with no more than eight strictures, compared to 31% in patients with more than eight strictures; when patients were categorized by number of strictureplasties, those with no more than four had a five-year actuarial reoperation rate of 14%, whereas patients who required more than four strictureplasties had an actuarial reoperation rate of 33%. The analysis showed that both strictures and strictureplasties were independently associated with recurrence, with recurrence risk increasing by 7% for each stricture and by 23% for each additional strictureplasty. The study was published in the July 2009 issue of the Journal of the American College of Surgeons (ACS).

"The presence of more strictures, alone, does not lead to an increase in recurrence, but is most probably a marker of more advanced or more aggressive disease. More work is necessary to better understand the reasons for these associations, and to identify potential interventions to reduce recurrence,” concluded lead author Adrian Greenstein, M.D., and colleagues of the department of surgery.

Strictureplasty is a surgical procedure performed in response to scar tissue that has built up in the intestinal wall from inflammatory bowel conditions, such as CD. The surgery involves excising the involved length of bowel, making a cut lengthwise along the resected bowel, and suturing the bowel widthwise (much like cutting a paper towel tube along its length, and taping the two short ends together to form a new tube). This has the effect of shortening and widening the segment of bowel, thus resolving the stricture. The process can be completed in multiple places along the bowel in one surgical session. The procedure is generally safe and effective for the near to long term. The procedure is most effective in the jejunum and ileum of the small intestine but not as effective in the duodenum; however, almost half of patients require reoperation.

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