Rates and Predictors of Endoscopic and Clinical Recurrence After Primary Ileocolic Resection for Crohn's Disease

Fortinsky, Kyle Joshua; Kevans, David; Qiang, Judy; Xu, Wei; Bellolio, Felipe; Steinhart, Hillary; Milgrom, Raquel; Greenberg, Gordon; Cohen, Zane; Macrae, Helen; Stempak, Joanne; McLeod, Robin; Silverberg, Mark S.


The utility of postoperative medical prophylaxis (POMP) and the treatment of mild endoscopic recurrence remain controversial.This study is a retrospective review of patients undergoing a primary ileocolic resection for CD at a single academic center. Endoscopic recurrence (ER) was defined using the Rutgeerts score (RS), and clinical recurrence (CR) was defined as symptoms of CD with endoscopic or radiologic evidence of neo-terminal ileal disease.There were 171 patients who met inclusion criteria. The cumulative probability of ER (RS ae i-1) at 1, 2, and 5 years was 29, 51, and 77 %, respectively. The only independent predictors of ER were the absence of POMP (HR 1.50; P = 0.03) and penetrating disease behavior (HR 1.50; P = 0.05). The cumulative probability of CR at 1, 2, and 5 years was 8, 13, and 27 %, respectively. There was a higher rate of clinical recurrence in patients with RS-2 compared to RS-1 on the initial postoperative endoscopy (HR 2.50; P = 0.02). In 11 patients not exposed to POMP with i-1 on initial endoscopy, only 2 patients (18 %) progressed endoscopically during the study period while 5 patients (45 %) regressed to i-0 on subsequent endoscopy without treatment.Postoperative medical prophylaxis decreased the likelihood of ER while certain phenotypes of CD appear to increase the risk of developing ER and CR. There may be a role for watchful waiting in patients with mild endoscopic recurrence on the initial postoperative endoscopy.

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Título según WOS: ID WOS:000392312200026 Not found in local WOS DB
Volumen: 62
Número: 1
Editorial: Springer
Fecha de publicación: 2017
Página de inicio: 188
Página final: 196
Notas: ISI