S2035 Prognostic Value of Modified Rutgeerts Score (i2a vs i2b) in Postoperative Crohn’s Disease: A Systematic Review, Meta-Analysis, and Meta-Regression Analysis

Introduction: Following resection for Crohn’s disease (CD), the prognostic significance of Rutgeerts’ i2a (isolated anastomotic lesions) vs i2b (>5 ileal aphthous lesions with or without anastomotic lesions) remain controversial. Prior meta-analyses did not include recent large cohorts and used variable outcome definitions. We performed an updated meta-analysis of all available data and outcomes to examine the clinical impact of i2a vs i2b stratification. Methods: A PRISMA-compliant systematic review was conducted using PubMed, Embase, and Cochrane databases for English-language studies reporting outcomes by i2 subclassification. Included studies reported clinical, endoscopic, surgical, or severe recurrence. Meta-analysis was performed using RevMan 5.4. Risk of bias was assessed using RoB 2.0 and ROBINS-I. Meta-regression and leave-one-out sensitivity analyses were performed in R, exploring the effects of publication year, sample size, and follow-up duration. Publication bias was evaluated using funnel plots. Results: Ten studies (n = 2,531) spanning 2016-2024 were included and analyzed. Cumulative risk estimates showed 5-year clinical recurrence rate of 65% (i2a) vs 79% (i2b), 5-year endoscopic recurrence rates of 47% vs 51%, and 5-year surgical recurrence rates of 30% vs 32%. Compared to i2b, i2a was associated with significantly lower clinical recurrence (RR 0.74, 95% CI [0.68–0.79], P < 0.00001, I² = 0%), endoscopic recurrence (RR 0.61, 95% CI [0.51–0.73], P < 0.00001, I² = 0%), and severe endoscopic progression (RR 0.66, 95% CI [0.50–0.87], P = 0.003, I² = 0%). No significant differences were found in surgical recurrence (RR 0.92, 95% CI [0.58–1.47], P = 0.73, I² = 45%) or global recurrence (RR 1.24, 95% CI [0.84–1.85], P = 0.28, I² = 0%). Funnel plots showed no publication bias. Meta-regression identified publication year and sample size as sources of heterogeneity; follow-up duration had no effect. Sensitivity analysis confirmed robustness of the findings. Conclusion: In postoperative Crohn’s disease monitoring, i2a lesions are associated with significantly lower rates of clinical, endoscopic, and severe recurrence compared to i2b, emphasizing the clinical prognostic utility of the modified Rutgeerts’ score. Prospective studies are warranted to guide tailored management strategies.