Risk of Late Postoperative Recurrence of Crohn's Disease in Patients in Endoscopic Remission After Ileocecal Resection, Over 10 Years at Multiple Centers.
[en] BACKGROUND & AIMS: The risk of recurrence of Crohn's disease (CD) from 1 to 10 years after surgery despite initial endoscopic remission (late post-operative recurrence) is not clear. METHODS: We performed a retrospective study, at 3 inflammatory bowel disease (IBD) centers in France and Belgium, of all patients with CD (n = 86) undergoing an ileocecal resection with curative intent from 2006 through 2016 who did not have endoscopic evidence for recurrence (Rutgeerts score less than i2) at their baseline assessment. Post-operative recurrence after baseline endoscopy was defined as a composite endpoint of at least 1 of the following: clinical recurrence, IBD-related hospitalization, occurrence of bowel damage, need for endoscopic balloon dilatation of the anastomosis, and need to repeat the surgery. Risk of mucosal disease progression was studied as a secondary outcome. RESULTS: The median time between surgery and baseline endoscopy was 7 months (IQR, 5.7-9.5 months); 40 patients (46.5%) received medical prophylaxis in this period. The median follow-up time was 3.5 years (IQR, 1.6-5.3 years). Thirty-five patients (40.7%) had a late post-operative recurrence of CD, with a median time to disease recurrence after baseline endoscopy of 14.2 months (IQR, 6.3-26.1 months). Recurrence status did not differ significantly between patients with Rutgeerts scores of i0 (20/55) or i1 (15/31) at baseline (P = .28) and was independent of medical prophylaxis (16/40 with prophylactic therapy vs 19/46 without prophylactic therapy; P = .90). Mucosal disease progressed in 29 of the 71 patients (40.8%) with available data. We did not identify risk factors for late post-operative recurrence of CD or mucosal disease progression. CONCLUSIONS: Among patients with CD treated by ileocecal resection, 40% of patients had a late recurrence, despite initial endoscopic remission, after a median follow-up time of 3.5 years. Tight monitoring of these patients is recommended beyond 18 months.
AMICONE, Caroline ; Centre Hospitalier Universitaire de Liège - CHU > Autres Services Médicaux > Service des soins intensifs
Louis, Edouard ; Université de Liège - ULiège > Département des sciences cliniques > Hépato-gastroentérologie
Maes, Sielte
REENAERS, Catherine ; Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Service de gastroentérologie, hépatologie, onco. digestive
Germain, Adeline
Baumann, Cédric
Bossuyt, Peter
Peyrin-Biroulet, Laurent
Language :
English
Title :
Risk of Late Postoperative Recurrence of Crohn's Disease in Patients in Endoscopic Remission After Ileocecal Resection, Over 10 Years at Multiple Centers.
Peyrin-Biroulet, L., Loftus, E.V., Colombel, J.-F., Sandborn, W.J., The natural history of adult Crohnʼs disease in population-based cohorts. Am J Gastroenterol 105 (2010), 289–297.
Olivera, P., Spinelli, A., Gower-Rousseau, C., Danese, S., Peyrin-Biroulet, L., Surgical rates in the era of biological therapy. Curr Opin Gastroenterol 33 (2017), 246–253.
Rutgeerts, P., Geboes, K., Vantrappen, G., Kerremans, R., Coenegrachts, J.L., Coremans, G., Natural history of recurrent Crohn's disease at the ileocolonic anastomosis after curative surgery. Gut 25 (1984), 665–672.
Rutgeerts, P., Geboes, K., Vantrappen, G., Beyls, J., Kerremans, R., Hiele, M., Predictability of the postoperative course of Crohn's disease. Gastroenterology 99 (1990), 956–963.
Gomollon, F., Dignass, A., Annese, V., et al. European Evidence-based Consensus on the Diagnosis and Management of Crohn's Disease 2016: Part 1: Diagnosis and Medical Management. J Crohn's Colitis 11 (2017), 3–25.
De Cruz, P., Kamm, M.A., Hamilton, A.L., et al. Crohn's disease management after intestinal resection: a randomised trial. Lancet 385 (2015), 1406–1417.
Vuitton, L., Marteau, P., Sandborn, W.J., et al. IOIBD technical review on endoscopic indices for Crohn's disease clinical trials. Gut 65 (2016), 1447–1455.
Nguyen, G.C., Loftus, E.V., Hirano, I., et al. American Gastroenterological Association Institute Guideline on the Management of Crohn's Disease After Surgical Resection. Gastroenterology 152 (2017), 271–275.
Onali, S., Calabrese, E., Petruzziello, C., et al. Post-operative recurrence of Crohn's disease: a prospective study at 5 years. Dig Liver Dis 48 (2016), 489–494.
Rivière, P., Vermeire, S., Irles-Depe, M., et al. No change in determining Crohn's disease recurrence or need for endoscopic or surgical intervention with modification of the Rutgeerts scoring system. Clin Gastroenterol Hepatol 17 (2019), 1643–1645.
Buisson, A., Chevaux, J.-B., Allen, P.B., Bommelaer, G., Peyrin-Biroulet, L., Review article: the natural history of postoperative Crohn's disease recurrence. Aliment Pharmacol Ther 35 (2012), 625–633.
Auzolle, C., Nancey, S., Tran-Minh, M.-L., et al. Male gender, active smoking and previous intestinal resection are risk factors for post-operative endoscopic recurrence in Crohn's disease: results from a prospective cohort study. Aliment Pharmacol Ther 48 (2018), 924–932.
Vuitton, L., Koch, S., Peyrin-Biroulet, L., Preventing postoperative recurrence in Crohn's disease: what does the future hold?. Drugs 73 (2013), 1749–1759.
Gionchetti, P., Dignass, A., Danese, S., et al. European Evidence-based Consensus on the Diagnosis and Management of Crohn's Disease 2016: Part 2: Surgical Management and Special Situations. J Crohn's Colitis 11 (2017), 135–149.
Magro, F., Gionchetti, P., Eliakim, R., et al. Third European Evidence-based Consensus on Diagnosis and Management of Ulcerative Colitis. Part 1: Definitions, Diagnosis, Extra-intestinal Manifestations, Pregnancy, Cancer Surveillance, Surgery, and Ileo-anal Pouch Disorders. J Crohn's Colitis 11 (2017), 649–670.
Barnes, E.L., Lightner, A.L., Regueiro, M., Perioperative and postoperative management of patients with Crohn's disease and ulcerative colitis. Clin Gastroenterol Hepatol 18 (2020), 1356–1366.
Burr, N.E., Hall, B., Hamlin, P.J., Selinger, C.P., Ford, A.C., O'Connor, A., Systematic review and network meta-analysis of medical therapies to prevent recurrence of post-operative Crohn's disease. J Crohns Colitis 13 (2019), 693–701.
Regueiro, M., Kip, K.E., Baidoo, L., Swoger, J.M., Schraut, W., Postoperative therapy with infliximab prevents long-term Crohn's disease recurrence. Clin Gastroenterol Hepatol 12 (2014), 1494–1502.e1.
Regueiro, M., Feagan, B.G., Zou, B., et al. Infliximab reduces endoscopic, but not clinical, recurrence of Crohn's disease after ileocolonic resection. Gastroenterology 150 (2016), 1568–1578.
Rivière, P., Vermeire, S., Irles-Depe, M., et al. Rates of post-operative recurrence of Crohn's disease and effects of immunosuppressive and biologic therapies. Clin Gastroenterol Hepatol, 2020 Apr 6 [E-pub ahead of print].