Background: Increased lymphatic vessel (LV) density has been found in uninflamed intestinal wall of patients with Crohn’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 < 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 < 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.
Article first published online 11 July 2013
Departments of *Hepatogastroenterology and
†Pathology, CHU UCL Mont-Godinne, Mont-Godinne, Belgium;
‡Inserm U 995, University of Lille France, CHRU Lille, Lille, France;
§Icahn Medical School at Mount Sinai, New York, NY;
‖Department of Pathology Cliniques Universitaires UCL Saint-Luc, Brussels, Belgium;
Departments of¶Hepatogastroenterology and
**Pathology, KUL Leuven, Leuven, Belgium;
††Department of Hepatogastroenterology, Hôpital Saint-Antoine, Paris, France;
‡‡UPMC University of Paris, Paris, France; and
§§CHRU Lille, Lille, France.
Reprints: Jean-François Rahier, MD, Service d’Hépatogastroentérologie, CHU UCL Mont Godinne, 1 avenue Dr Therasse, 5530 Yvoir, Belgium (e-mail: firstname.lastname@example.org).
The authors have no conflicts of interest to disclose.
J.-F. Rahier has received lecture fees for speaking at medical events from Abbott Laboratories and Schering-Plough, as well as advisory board fees from GlaxoSmithKline. He had full access to all data and takes full responsibility for the veracity of data and analyses.
Received January 17, 2013
Accepted April 15, 2013