How frequent is recurrence of Crohn’s disease after ileocolonic resection?
Late postoperative recurrence of Crohn’s disease is common. Clinicians should continue to monitor patients beyond their first postoperative year.
Pouillon L, Remen T, Amicone C, et al. Risk of Late Postoperative Recurrence of Crohn’s Disease in Patients in Endoscopic Remission After Ileocecal Resection, Over 10 Years at Multiple Centers. Clin Gastroenterol Hepatol. 2021;19(6):1218-1225.e4; https://linkinghub.elsevier.com/retrieve/pii/S1542-3565(20)30686-8
Researchers at three European IBD centers analyzed data from 96 patients with Crohn’s disease who underwent ileocolonic resection between 2006 and 2016. The procedures were performed with a curative intent.
Patients underwent endoscopy at a median of seven months after surgery (Interquartile range [IQR]: 5.7–9.5 months). At that time, none of the patients were found to have more than five aphthous ulcers at the ileocolonic anastomosis (Rutgeerts score of i0 or i1), and were not considered to have recurrent disease. A second post-operative endoscopic assessment was performed after an additional median interval of 3.5 years (IQR: 1.6–5.3 years). Fewer than half of the patients received medical prophylaxis with an immunomodulator or biologic agent between their surgery and their first postoperative endoscopy. Disease recurrence was defined as clinical recurrence, IBD-related hospitalization, bowel damage, need for endoscopic balloon dilation of the anastomosis, or need for repeat surgery.
According to the authors, 40.7% of patients experienced late disease recurrence, occurring a median 14.2 months following postoperative baseline endoscopy (IQR: 6.3–26.1 months). Rates of recurrence in the first and third years after baseline endoscopy were 17.4% and 36%, respectively.
Statistical analyses did not identify predictors of late postoperative disease recurrence, but the authors noted a trend towards higher rates of late recurrence among patients with a Rutgeerts score of i1 at the time of the first endoscopic procedure, compared to those with a score of i0 at that time. Of 71 patients with endoscopic data available at last follow-up, 41% demonstrated mucosal disease progression.
Study Design: Retrospective cohort
Funding: Not stated
Level of Evidence: 2b
The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.