Published online Jun 7, 2016. doi: 10.3748/wjg.v22.i21.5068
Peer-review started: February 26, 2016
First decision: March 31, 2016
Revised: April 14, 2016
Accepted: April 20, 2016
Article in press: April 20, 2016
Published online: June 7, 2016
Processing time: 95 Days and 19.1 Hours
AIM: To investigate whether an endoscopy-based management could prevent the long-term risk of postoperative recurrence.
METHODS: From the pathology department database, we retrospectively retrieved the data of all the patients operated on for Crohn’s disease (CD) in our center (1986-2015). Endoscopy-based management was defined as systematic postoperative colonoscopy (median time after surgery = 9.5 mo) in patients with no clinical postoperative recurrence at the time of endoscopy.
RESULTS: From 205 patients who underwent surgery, 161 patients (follow-up > 6 mo) were included. Endoscopic postoperative recurrence occurred in 67.6%, 79.7%, and 95.5% of the patients, respectively 5, 10 and 20 years after surgery. The rate of clinical postoperative recurrence was 61.4%, 75.9%, and 92.5% at 5, 10 and 20 years, respectively. The rate of surgical postoperative recurrence was 19.0%, 38.9% and 64.7%, respectively, 5, 10 and 20 years after surgery. In multivariate analysis, previous intestinal resection, prior exposure to anti-TNF therapy before surgery, and fistulizing phenotype (B3) were postoperative risk factors. Previous perianal abscess/fistula (other perianal lesions excluded), were predictive of only symptomatic recurrence. In multivariate analysis, an endoscopy-based management (n = 49/161) prevented clinical (HR = 0.4, 95%CI: 0.25-0.66, P < 0.001) and surgical postoperative recurrence (HR = 0.30, 95%CI: 0.13-0.70, P = 0.006).
CONCLUSION: Endoscopy-based management should be recommended in all CD patients within the first year after surgery as it highly decreases the long-term risk of clinical recurrence and reoperation.
Core tip: Although often recommended, the impact of an endoscopy-based management following surgery remains poorly investigated in Crohn’s patients. We aimed to investigate whether an endoscopy-based management could prevent the long-term risk of postoperative recurrence in Crohn’s disease (CD). We retrospectively retrieved the data of 161 patients operated on for CD in our center. We showed for the first time, that an endoscopy-based management decreased the long-term risk of clinical and surgical postoperative recurrence in CD and the risk of reoperation.