Nipple Valve Anastomosis for Preventing Recurrence of Crohn Disease in the Neoterminal Ileum after Ileocolic Resection: A Prospective Pilot Study

Abstract

Background: Crohn disease may recur within months in the neoterminal ileum after ileocolic resection. Coloileal reflux may be a factor contributing to recurrence. This study tests the effect of a nipple valve anastomosis in preventing symptomatic and endoscopic neoileal recurrence. Methods: Between January 1993 and April 1997, 25 patients with Crohn disease were resected and anastomosed with an ileocolic nipple valve. Postoperatively, the patients were given 5-aminosalicylic acid, 0.75-3 g/daily. Regular follow-up included the Harvey-Bradshaw index, ileocolonoscopy, and hydrocolonic sonography. Results: After 1 year 2 of 25 patients (8%) had a symptomatic and 3 of 23 patients (13%) an endoscopic recurrence. There was no symptomatic neoileal recurrence between 1 and 5 years. After 3 years 6 of 13 patients (46%) had an endoscopic recurrence. After 5 years 4 of 11 patients (36%) had a symptomatic recurrence. Conclusions: These results may suggest that a nipple valve anstomosis delays and perhaps prevents symptomatic recurrence of Crohn disease in the neoterminal ileum.