A significant proportion of patients with Crohn's disease will require surgery at some point in their disease course. However, up to 80% of patients will demonstrate endoscopic recurrence in the neoterminal ileum within 12 months of surgery. Identifying predictive high-risk factors to prevent a postoperative recurrence remains challenging and is not yet standardized.
This prospective multicenter study included 213 CD patients after ileocolonic resection (ICR). A standardized postoperative prophylactic therapeutic management algorithm based on the presence or absence of risk factors was proposed. The high-risk factors were active smoking, penetrating disease, and previous ICR.
Six months after surgery, 181 patients (84.9%) underwent ileocolonoscopy. Endoscopic recurrence (Rutgeerts’ score ≥i2b) was higher in patients without than with prophylactic therapy in both low-risk (45% vs 16%, respectively; P=.012) and high-risk (49% vs 26%, respectively; P=.019) groups. For clinical risk factors incorporated into the management algorithm of this study, the area under the curve (AUC) for endoscopic recurrence was 0.70 (95% confidence interval [CI], 0.61-0.79). Combining histologic elements with the clinical risk factors resulted in an AUC of 0.73 (95% CI, 0.64-0.81).
Arkenbosch JHC, Beelen EMJ, Dijkstra G, et al. Prophylactic medication for the prevention of endoscopic recurrence in Crohn’s disease: a prospective study based on clinical risk stratification. J Crohns Colitis
2022 Sep 12. (Epub ahead of print) (https://doi.org/10.1093/ecco-jcc/jjac128