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

Abstract

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.

Crohn's disease after surgery: Changes in post‐operative management strategies over time and their impact on long‐term re‐operation rate—A retrospective multicentre real‐world study

“…Several factors may contribute to this low surgical recurrence rate, including improved medical care, referral centre management, reduced smoking habits, patient education, 34,37,38,42–44 and, even considering the changes in surgical techniques are the historical prerogative of only the III cohort, a lower risk of surgical recurrence was not observed in the last cohort compared with the historical cohorts. According to recent data, in fact, no changes in post‐operative recurrence rate were observed according to different surgical techniques 45,46 …”

“…The study may be underpowered because only 12.8% of patients had repeated surgery; our findings, however, are in line with population-based studies performed in different areas of the world, which report similar incidence rate of recurrent surgery. 35,[39][40][41] Several factors may contribute to this low surgical recurrence rate, including improved medical care, referral centre management, reduced smoking habits, patient education, 34,37,38,[42][43][44] and, even considering the changes in surgical techniques are the historical prerogative of only the III cohort, a lower risk of surgical recurrence was not observed in the last cohort compared with the historical cohorts. According to recent data, in fact, no changes in post-operative recurrence rate were observed according to different surgical techniques.…”