Management of postoperative Crohn’s disease

Abstract

Surgical treatment does not cure Crohn's disease, and postoperative recurrence is a feature of the clinical course of the disease. Ileocolonoscopy remains the gold standard for the surveillance of recurrent Crohn's disease and should be performed 6-12 months after an operation. Many other non-invasive techniques are also useful and complement endoscopy for the early diagnosis of postoperative recurrence. Anti-TNF agents show great efficacy for the prevention of postoperative recurrence, and long-term use can maintain remission. It remains undetermined whether early treatment after postoperative endoscopic recurrence is ultimately as efficacious as prophylactic therapy.

CT Enterography for Surveillance of Anastomotic Recurrence within 12 Months of Bowel Resection in Patients with Crohn's Disease: An Observational Study Using an 8-Year Registry

“…The postsurgical recurrence of CD is often clinically silent: according to one systematic review (4), more than half of patients with recurrence within 1 year of surgery did not have remarkable symptoms. Accordingly, all CD patients are recommended to undergo ileocolonoscopic surveillance 6–12 months after bowel surgery for the early detection of recurrence ( 1 2 5 6 ). In support of this recommendation, a recent randomized clinical trial (the POCER trial) showed that early routine ileocolonoscopy six months after bowel surgery for CD and appropriate treatment step-up in the case of endoscopic recurrence could improve patient outcomes ( 7 ).…”