Endoscopy-based management decreases the risk of postoperative recurrences in Crohn's disease

作者：Boucher Anne Laure; Pereira Bruno; Decousus Stephanie; Goutte Marion; Goutorbe Felix; Dubois Anne; Gagniere Johan; Borderon Corinne; Joubert Juliette; Pezet Denis; Dapoigny Michel; Dechelotte Pierre J; Bommelaer Gilles; Buisson Anthony^*

来源：World Journal of Gastroenterology, 2016, 22(21): 5068-5078.

DOI：10.3748/wjg.v22.i21.5068

• Crohn's disease
• Postoperative recurrence
• Endoscopy
• Prevalence
• Risk factors

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.

• 出版日期2016-6-7