title: Decreased lymphatic vessel density is associated with postoperative endoscopic recurrence in Crohn's disease.
abstract: 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.
authors.affiliation: Department of Hepatogastroenterology and †Pathology, CHU UCL Mont-Godinne, Mont-Godinne, Belgium. jfrahier@gmail.com
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Rahier
authors.forename: Laurent
authors.initials: L
authors.lastname: Dubuquoy
authors.forename: Jean-Frédéric
authors.initials: JF
authors.lastname: Colombel
authors.forename: Anne
authors.initials: A
authors.lastname: Jouret-Mourin
authors.forename: Monique
authors.initials: M
authors.lastname: Delos
authors.forename: Marc
authors.initials: M
authors.lastname: Ferrante
authors.forename: Harry
authors.initials: H
authors.lastname: Sokol
authors.forename: Gert De
authors.initials: GD
authors.lastname: Hertogh
authors.forename: Julia
authors.initials: J
authors.lastname: Salleron
authors.forename: Karel
authors.initials: K
authors.lastname: Geboes
authors.forename: Pierre
authors.initials: P
authors.lastname: Desreumaux
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D003424:Crohn Disease / Q000150:complications / Q000473:pathology* / Q000601:surgery; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007124:Immunoenzyme Techniques; D042601:Lymphatic Vessels / Q000473:pathology*; D008297:Male; D009197:Myenteric Plexus / Q000378:metabolism; D011183:Postoperative Complications; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D042582:Vascular Endothelial Growth Factor C / Q000378:metabolism; D055815:Young Adult
chemical_list: C467486:VEGFC protein, human; D042582:Vascular Endothelial Growth Factor C