Colonoscopy-guided therapy for the prevention of post-operative recurrence of Crohn’s disease

Cândia, Roberto; Ibáñez, Patricio; Nguyen, Geoffrey C.

doi:10.1002/14651858.cd012328

Cited by 4 publications

(3 citation statements)

References 31 publications

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“…In fact, an endoscopic evaluation with ileocolonoscopy is recommended 6 to 12 months after surgery [25]. Nevertheless, whether endoscopic monitoring and prophylactic therapy guided by colonoscopy are beneficial compared to empirical initiation shortly after surgery is still a matter of debate [38].…”

Section: Discussionmentioning

confidence: 99%

Postoperative Recurrence of Crohn’s Disease–Is the Early Use of Postoperative Immunomodulators Able to Modify Prognosis?

Temido,

Oliveira,

Silva

et al. 2023

Gastrointestinal Disorders

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Introduction: Many patients with Crohn’s Disease (CD) require surgical resection during their lifetime. Nevertheless, postoperative recurrence (POR) is common. Risk factors for POR are still yet to be completely established, but some prognostic factors have already been widely recognized. Patients that undergo early postoperative immunomodulators (EPI) (azathioprine or biological therapy) seem to have a lower risk of recurrence. We aimed at assessing whether or not EPI is effective in preventing POR and at the same time validating traditional and new risk factors for POR. Methods: A single-center retrospective cohort study was performed. Review of clinical, demographic and histopathological characteristics of patients undergoing ileocolonic resection for CD between 2015 and 2020 was performed. EPI was defined as the restarting or introduction of azathioprine or biologics within 8 weeks after surgery. Presence of recurrence was defined as Rutgeerts score ≥ i2. Results: Sixty-five patients were included. The median age at diagnosis was 25 years (inter-quartile range 20–33 years). POR was present in 44.6% of patients, and the median time from surgery to recurrence was 2 years. EPI was the therapeutic option in 36 patients (55.4%). Univariate analysis identified as predictors of POR within 2 years: the behavior of the disease and not taking azathioprine or biologics prior to the surgery. Moreover, univariate analysis identified as predictors of time to POR: behavior of disease, less than 5 years between diagnosis and surgery and the absence of immunomodulatory therapy prior to the surgery. Multivariable analysis revealed that EPI, after adjusting for other predictors, was not associated with a reduction in POR. Conclusions: EPI may not have a protective effect against recurrence. The strength of prognostic factors for POR may not be modified by EPI.

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Section: Discussionmentioning

confidence: 99%

Postoperative Recurrence of Crohn’s Disease–Is the Early Use of Postoperative Immunomodulators Able to Modify Prognosis?

Temido,

Oliveira,

Silva

et al. 2023

Gastrointestinal Disorders

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“…Although the use of early postoperative endoscopy is recommended in the guidelines of several IBD scientific societies because of the predictive value of endoscopic recurrence on subsequent clinical relapse [ 7 , 10 , 24 ], there is little data in the literature on its use and its impact on the clinical outcome of patients. A recent Cochrane systematic review and meta-analysis on the impact of colonoscopy-guided post-operative treatment suggested a trend toward a lower clinical recurrence and toward a lower endoscopic activity score at 18 months [ 16 ]. However, the main conclusion was that there was insufficient data and that particularly the impact on surgical recurrence had not been appropriately studied.…”

Section: Discussionmentioning

confidence: 99%

Early Post-Operative Endoscopy Is Associated with Lower Surgical Recurrence of Crohn’s Disease: A Retrospective Study of Three Successive Cohorts

Amicone

Marques

Reenaers

et al. 2022

Gastroenterology Research and Practice

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Background. The severity of endoscopic recurrence during the first year after intestinal resection for Crohn’s disease is predictive of clinical recurrence. The aim of our study was to assess the impact of the implementation of an ileocolonoscopy during the first year after surgery on surgical recurrence. Methods. All patients who underwent a first intestinal resection for Crohn’s disease between 1992 and 2018 at the University Hospital of Liège were retrospectively included. The time to surgical recurrence was compared in three successive groups of patients operated on in the period 1992–2001 (group A), 2002–2011 (group B), and 2012–2020 (group C) using the Kaplan–Meier method and the Log-Rank test. To identify independent prognostic factors, a multivariate analysis was used via the Cox model. Results. 223 patients (group A = 69, group B = 94, group C = 60) were included. Probabilities of surgical recurrence were significantly lower in group C (2.2% and 4.7% at 3 and 5 years, respectively) compared with group B (4.2% and 7.6% at 3 and 5 years, respectively) and with group A (9% and 18.2% at 3 and 5 years, respectively) ( p = 0.0089 ). Ileocolonoscopy during the year after surgery was associated with a significantly reduced surgical recurrence rate in univariate and multivariate analysis (HR = 0.31, p = 0.0049 ). Conclusion. The implementation of an early ileocolonoscopy after surgery for Crohn’s disease since early 2000 has been associated with a reduced surgical recurrence over the last 30 years.

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“…Case-control and cohort studies were assessed using the Newcastle-Ottawa scale (NOS) [19] consisting of three domains: (1) selection of subjects, (2) comparability of groups, and (3) assessment of outcome. A score of 0-9 was allocated to each relevant study.…”

Section: Quality Assessmentmentioning

confidence: 99%

Vitamin D and the risk of latent tuberculosis infection: a meta-analysis

Cao

Wang

Liu

et al. 2021

Preprint

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Objective Latent tuberculosis infection (LTBI) may be a risk of developing tuberculosis (TB) and thus a health hazard. The aim of this meta-analysis is to explore the association between vitamin D and LTBI. Methods Databases including PubMed, Embase, Scopus, and ProQuest were electronically searched to identify observational or interventional studies that reported the association between vitamin D and LTBI. The retrieval time is limited from inception to September 2021. Two reviewers independently screened literature, extracted data, and assessed risk bias of included studies. Meta-analysis was performed by using STATA 12.0 software. Results A total of 5 studies involving 2 case-control studies and 3 cohort studies were included. The meta-analysis result showed that the serum level of vitamin D was associated with the risk of LTBI (OR=0.32, 95%CI: 0.12-0.85, P=0.022). The result from cohort studies suggested that relatively high vitamin D level was a protective factor for LTBI (RR=0.67, 95%CI: 0.48-0.92, P=0.015). Conclusions Our meta-analysis suggested that serum vitamin D levels were associated with LTBI, and relatively high serum vitamin D level was a protective factor for LTBI. Further RCTs are needed to verify whether vitamin D supplementation prevents LTBI.

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Colonoscopy-guided therapy for the prevention of post-operative recurrence of Crohn’s disease

Cited by 4 publications

References 31 publications

Postoperative Recurrence of Crohn’s Disease–Is the Early Use of Postoperative Immunomodulators Able to Modify Prognosis?

Postoperative Recurrence of Crohn’s Disease–Is the Early Use of Postoperative Immunomodulators Able to Modify Prognosis?

Early Post-Operative Endoscopy Is Associated with Lower Surgical Recurrence of Crohn’s Disease: A Retrospective Study of Three Successive Cohorts

Vitamin D and the risk of latent tuberculosis infection: a meta-analysis

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