Abstract / Description of output
Background: The risk of endoscopic postoperative recurrence (ePOR) remains high within 1 year after ileocaecal resection (ICR) for ileal Crohn’s disease (CD). Currently, there is no consensus in how to reduce risk of ePOR, clinical(c)POR or surgical(s)POR on long-term. This study aims to evaluate the impact of two strategies on POR: early medical prophylaxis (proactive strategy) versus treatment driven by findings at elective endoscopy 6-12 months after ICR (reactive strategy).
Methods: A retrospective, observational, multicentre, superiority study was performed including CD patients undergoing first ICR between 2008 and 2019. Patients were assigned to cohort 1 if prophylactic medical therapy was administered early after ICR, or to cohort 2 if no postoperative prophylaxis was started and medical treatment was driven by endoscopic findings 6-12 months after ICR. The primary endpoint was the rate of ePOR evaluated at ileocolonoscopy 6-12 months post ICR and was defined as Rutgeerts score >i1. Statistical analyses were performed with SPSS version 27.
Results: In total 336 patients were included from 26 centres in 9 European countries. Cohort 1 contained 48.8% and cohort 2 51.2% of all patients. Baseline demographics and disease characteristics are shown in Table 1. Both cohorts were comparable considering gender, age, smoking status, disease duration, disease phenotype, indication for surgery and biochemical markers of inflammation. Preoperatively, immunosuppressants and anti-TNF were more frequently used in cohort 1. There was no significant difference in postoperative complications between the two cohorts. Univariate logistic regression analysis showed a significantly higher rate of ePOR at endoscopy 6-12 months after surgery in cohort 2 patients (OR 2.03, 95%CI 1.30- 3.18; P=0.002) (Fig1). Multiple logistic regression analysis with adjustment for age, smoking status, preoperative medical treatment, disease activity, surgical indication and propensity score (including differences per country) confirms the significant difference between cohort 1 and 2 (OR 1.87, 95%CI 1.10-3.16; P=0.02). Sub-analysis of the subgroup of patients with non-penetrating phenotype again confirmed this observation (OR 2.26, 95%CI 1.05-4.86; P= 0.038).
Conclusion: In this retrospective, European multicentre study, initiation of medical treatment in patients with Crohn’s disease immediately after ileocaecal resection was associ- ated with a lower risk of endoscopic postoperative recurrence 6-12 months after surgery compared to endoscopy-driven treatment.
Methods: A retrospective, observational, multicentre, superiority study was performed including CD patients undergoing first ICR between 2008 and 2019. Patients were assigned to cohort 1 if prophylactic medical therapy was administered early after ICR, or to cohort 2 if no postoperative prophylaxis was started and medical treatment was driven by endoscopic findings 6-12 months after ICR. The primary endpoint was the rate of ePOR evaluated at ileocolonoscopy 6-12 months post ICR and was defined as Rutgeerts score >i1. Statistical analyses were performed with SPSS version 27.
Results: In total 336 patients were included from 26 centres in 9 European countries. Cohort 1 contained 48.8% and cohort 2 51.2% of all patients. Baseline demographics and disease characteristics are shown in Table 1. Both cohorts were comparable considering gender, age, smoking status, disease duration, disease phenotype, indication for surgery and biochemical markers of inflammation. Preoperatively, immunosuppressants and anti-TNF were more frequently used in cohort 1. There was no significant difference in postoperative complications between the two cohorts. Univariate logistic regression analysis showed a significantly higher rate of ePOR at endoscopy 6-12 months after surgery in cohort 2 patients (OR 2.03, 95%CI 1.30- 3.18; P=0.002) (Fig1). Multiple logistic regression analysis with adjustment for age, smoking status, preoperative medical treatment, disease activity, surgical indication and propensity score (including differences per country) confirms the significant difference between cohort 1 and 2 (OR 1.87, 95%CI 1.10-3.16; P=0.02). Sub-analysis of the subgroup of patients with non-penetrating phenotype again confirmed this observation (OR 2.26, 95%CI 1.05-4.86; P= 0.038).
Conclusion: In this retrospective, European multicentre study, initiation of medical treatment in patients with Crohn’s disease immediately after ileocaecal resection was associ- ated with a lower risk of endoscopic postoperative recurrence 6-12 months after surgery compared to endoscopy-driven treatment.
| Original language | English |
|---|---|
| Pages (from-to) | 602-603 |
| Journal | Gastroenterology |
| Volume | 162 |
| Issue number | 7 |
| DOIs | |
| Publication status | Published - 1 Jun 2022 |
Keywords / Materials (for Non-textual outputs)
- Inflammatory Bowel Disease
- Biologics
- Crohn's Disease