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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Mar 27, 2024; 16(3): 740-750
Published online Mar 27, 2024. doi: 10.4240/wjgs.v16.i3.740
Pre-operative visceral adipose tissue radiodensity is a potentially novel prognostic biomarker for early endoscopic post-operative recurrence in Crohn’s disease
Phillip Gu, Shishir Dube, Norman Gellada, So Yung Choi, Susan Win, Yoo Jin Lee, Shaohong Yang, Talin Haritunians, Gil Y Melmed, Eric A Vasiliauskas, Niru Bonthala, Gaurav Syal, Andres J Yarur, David Ziring, Shervin Rabizadeh, Phillip Fleshner, Cindy Kallman, Suzanne Devkota, Stephan R Targan, Dalin Li, Dermot PB McGovern
Phillip Gu, Shishir Dube, Shaohong Yang, Talin Haritunians, Gil Y Melmed, Eric A Vasiliauskas, Andres J Yarur, Suzanne Devkota, Stephan R Targan, Dalin Li, Dermot PB McGovern, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
Norman Gellada, Susan Win, Cindy Kallman, Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
So Yung Choi, Department of Biostatistics Shared Resource, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
Yoo Jin Lee, Department of Internal Medicine, Keimyung University School of Medicine, Daegu 42601, South Korea
Niru Bonthala, Department of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, United States
Gaurav Syal, Department of Medicine, University of California at San Diego, San Diego, CA 92093, United States
David Ziring, Shervin Rabizadeh, Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
Phillip Fleshner, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
Author contributions: Gu P is the guarantor of the article and was involved in concept and design, data collection, statistical analysis, drafting of manuscript, and final approval of manuscript; Dube S and Choi SY were involved in statistical analysis, drafting of the manuscript, and final approval of manuscript; Gellada N, Win S, Lee YJ and Yang S were involved in the data collection, drafting of the manuscript, and final approval of manuscript; Haritunians T and Li D were involved in data analysis and interpretation, drafting of manuscript and final approval of manuscript; Melmed GY, Yarur AJ, Fleshner P, Kallman C and Devkota S were involved in study concept and design, data interpretation, drafting of manuscript and final approval of manuscript; Vasiliauskas EA, Bonthala N, Syal G, Ziring D and Targan SR were involved in data interpretation, drafting of manuscript and final approval of manuscript; Rabizadeh S was involved in study concept and design, drafting of manuscript and final approval of manuscript; McGovern DPB was involved in concept and design, statistical analysis, drafting of manuscript and final approval of manuscript.
Supported by American College of Gastroenterology, Clinical Research Award 2022, No. ACG-CR-040-2022; National Institute of Diabetes and Digestive and Kidney Diseases, U01, No. 2299170; and Helmsley Charitable Trust, No. 2352240.
Institutional review board statement: This study was approved by the Institutional Review Board of Cedars-Sinai Medical Center (IRB #3358).
Informed consent statement: Because this was a retrospective study, informed consent was not required by the IRB.
Conflict-of-interest statement: Li D has received consulting fees from Prometheus Biosciences Inc; Syal G has received research support from Pfizer; Yarur AJ has received consulting fees from Bristol Myers Squibb, Arena, Pfizer, Takeda and Landos; Targan SR serves on the scientific advisory board for Seaver Foundation for Austim, and has stock options in Promethus Biosciences Inc; Ziring D is on the speaking bureau for AbbVie, Prometheus Labs, and Regeneron; Rabizadeh S has advised for Prometheus and Janssen; Melmed GY has received consulting fees from Abbvie, Arena Pharmaceuticals, Bristol-Myers Squibb, Boehringer-Ingelheim, Celgene, Dieta, Entasis, Fresenius Kabi, Genentech, Gilead, Janssen, Medtronic, Merck, Oshi, Prometheus Labs, Pfizer, Takeda, Techlab; Fleshner P has received consulting fees from Takeda; McGovern DPB has received consulting fees from Takeda, Prometheus Biosciences Inc, Prometheus Labs; Other authors have no conflicts of interests to disclose.
Data sharing statement: Data available on request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Phillip Gu, MD, Assistant Professor, Doctor, Department of Medicine, Cedars-Sinai Medical Center, 8730 Alden Dr Suite E222, Los Angeles, CA 90048, United States. phillipgu12@gmail.com
Received: November 30, 2023
Peer-review started: November 30, 2023
First decision: December 25, 2023
Revised: January 4, 2024
Accepted: January 30, 2024
Article in press: January 30, 2024
Published online: March 27, 2024
ARTICLE HIGHLIGHTS
Research background
Strategies for mitigating post-operative recurrence (POR) of Crohn’s disease (CD) require accurate risk stratification of patients for POR, but aside from smoking, internal penetrating disease, and prior surgeries, many risk factors are variably supported by the literature. Inflammatory mesenteric adipose tissue has been implicated in the pathogenesis of POR in CD, but its prognostic value is uncertain, in-part, due to difficulties studying it non-invasively.
Research motivation
Accurate risk stratification for POR of CD is important for informing post-operative management strategies to mitigate POR. Many prognostic markers have modest predictive accuracy. Thus, identifying new and accurate prognostic markers for POR is important.
Research objectives
The objective of this study was to establish the prognostic value of pre-operative radiographic mesenteric parameters for early endoscopic POR.
Research methods
We conducted a retrospective cohort study if CD patients undergoing ileocecal and/or small bowel resection with available CT abdomen/pelvis within 6 months prior to surgery and underwent endoscopic evaluation for POR within 15 months after surgery. The primary outcome was early endoscopic POR defined as Rutgeerts ≥ i2 on post-operative endoscopy within 15 months of after surgery. Multivariable regression analyses were performed to determine the independent association between pre-operative radiographic mesenteric parameters and POR.
Research results
Analysis of 139 subjects found lower visceral adipose tissue (VAT) radiodensity was independently associated with early endoscopic POR (adjusted odds ratio: 0.59, 95% confidence interval: 0.38-0.90).
Research conclusions
VAT radiodensity is a potentially novel imaging prognostic marker for POR in CD.
Research perspectives
While larger studies are needed to validate our findings, VAT radiodensity is potentially a novel prognostic marker for POR that can be easily extracted from available CT imaging and help inform risk of POR. Lower VAT radiodensity has been suggested to reflect poor fat quality, so translational studies are required to understand possible underlying mechanisms of poor mesenteric fat quality that may contribute to POR and are reflected in VAT radiodensity.
