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Rates and Predictors of Endoscopic and Clinical Recurrence After Primary Ileocolic Resection for Crohn’s Disease

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Abstract

Background and Aims

The utility of postoperative medical prophylaxis (POMP) and the treatment of mild endoscopic recurrence remain controversial.

Methods

This study is a retrospective review of patients undergoing a primary ileocolic resection for CD at a single academic center. Endoscopic recurrence (ER) was defined using the Rutgeerts score (RS), and clinical recurrence (CR) was defined as symptoms of CD with endoscopic or radiologic evidence of neo-terminal ileal disease.

Results

There were 171 patients who met inclusion criteria. The cumulative probability of ER (RS ≥ i-1) at 1, 2, and 5 years was 29, 51, and 77 %, respectively. The only independent predictors of ER were the absence of POMP (HR 1.50; P = 0.03) and penetrating disease behavior (HR 1.50; P = 0.05). The cumulative probability of CR at 1, 2, and 5 years was 8, 13, and 27 %, respectively. There was a higher rate of clinical recurrence in patients with RS-2 compared to RS-1 on the initial postoperative endoscopy (HR 2.50; P = 0.02). In 11 patients not exposed to POMP with i-1 on initial endoscopy, only 2 patients (18 %) progressed endoscopically during the study period while 5 patients (45 %) regressed to i-0 on subsequent endoscopy without treatment.

Conclusions

Postoperative medical prophylaxis decreased the likelihood of ER while certain phenotypes of CD appear to increase the risk of developing ER and CR. There may be a role for watchful waiting in patients with mild endoscopic recurrence on the initial postoperative endoscopy.

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Authors and Affiliations

  1. University of Toronto, Toronto, Canada

    Kyle Joshua Fortinsky, David Kevans, Judy Qiang, Wei Xu, Felipe Bellolio, Hillary Steinhart, Raquel Milgrom, Gordon Greenberg, Zane Cohen, Helen Macrae, Joanne Stempak, Robin McLeod & Mark S. Silverberg

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  1. Kyle Joshua Fortinsky
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  2. David Kevans
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Correspondence to Kyle Joshua Fortinsky.

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Fortinsky, K.J., Kevans, D., Qiang, J. et al. Rates and Predictors of Endoscopic and Clinical Recurrence After Primary Ileocolic Resection for Crohn’s Disease. Dig Dis Sci 62, 188–196 (2017). https://doi.org/10.1007/s10620-016-4351-7

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  • DOI: https://doi.org/10.1007/s10620-016-4351-7

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