Isoperistaltic Anastomosis Increases Neo-Terminal Ileum Intubation Rates in Crohn's Disease Patients

Area of Science:

• Gastroenterology
• Surgical Oncology
• Endoscopic Surgery

Background:

• Side-to-side stapled ileocolonic anastomosis (ICA) is a common surgical technique for Crohn's disease (CD).
• The alignment of the anastomosis, specifically antiperistaltic ICA (APICA) versus isoperistaltic ICA (IPICA), may influence the ease of intubating the neo-terminal ileum (neo-TI).
• Successful neo-TI intubation is crucial for effective endoscopic follow-up and management of CD.

Purpose of the Study:

• To compare the feasibility of postsurgical neo-terminal ileum intubation between APICA and IPICA.
• To evaluate the impact of anastomosis alignment on endoscopic surveillance in CD patients.

Main Methods:

• Retrospective analysis of Crohn's disease patients (≥18 years) who underwent ileocolonic resection between 2010 and 2022.
• Inclusion criteria: completed ileocolonoscopy within 24 months post-surgery.
• Exclusion criteria: non-APICA/IPICA anastomoses, ileostomy, unavailable ileocolonoscopy reports.

Main Results:

• 148 patients included: 76.4% APICA and 23.6% IPICA. Groups were comparable in demographics and surgical factors.
• Anastomotic disease recurrence (Rutgeerts score ≥ 2b) was similar between groups (37.6% APICA vs. 37.1% IPICA, P = 0.563).
• Excluding strictures and poor preparation, neo-TI intubation success was significantly higher in IPICA (100%) compared to APICA (87.4%, P = 0.038).

Conclusions:

• APICA and IPICA demonstrate comparable safety profiles and rates of endoscopic recurrence in CD.
• IPICA facilitates easier neo-TI intubation, achieving 100% success without intubation failure.
• The improved intubation feasibility with IPICA enhances endoscopic surveillance and management strategies for Crohn's disease.