title: Impact of endoscopic monitoring in postoperative Crohn's disease patients already receiving pharmacological prevention of recurrence.
abstract: BACKGROUND
  Current guidelines address the initiation of treatment to prevent postoperative recurrence (PR) after ileo-cecal resection in Crohn's disease (CD), but appropriate management of postoperative CD patients who are already receiving treatment to prevent PR is yet to be defined. Usefulness of endoscopic monitoring in this scenario remains uncertain.
  
  
  OBJECTIVE
  To evaluate the usefulness of endoscopy-based management of postoperative CD patients who are already under pharmacological prevention of PR.
  
  
  METHODS
  Retrospective review of clinical outcome of all CD patients with ileo-cecal resection who underwent postoperative colonoscopy between 2004 and 2013 at our centre. Postoperative endoscopic findings were classified as no endoscopic recurrence (Rutgeerts i0-i1) or endoscopic recurrence (Rutgeerts i2-i4). Patients with endoscopic recurrence were classified as "endoscopy-based management (EBM)" if treatment step-up after endoscopy, or "non EBM (N-EBM)". Clinical recurrence was considered if re-operation, CD related hospitalization or treatment change. Time until clinical recurrence or the end of the follow up was considered.
  
  
  RESULTS
  One hundred sixty six patients initially identified. One hundred twenty nine (77%) under pharmacological prevention of PR at the time of colonoscopy were analyzed: 34% were receiving aminosalicylates, 50% thiopurines, 11% anti-TNF, 5% combo. Colonoscopy showed endoscopic recurrence in 57% of patients; those with N-EBM were more likely to have clinical recurrence than patients with EBM along the follow up (p = 0.01). Conclussions: Endoscopic monitoring could be useful in postoperative CD patients also in patients already receiving pharmacological treatment to prevent PR.
authors.affiliation: Servicio de Gastroenterología y Hepatología, Hospital Universitario Puerta de Hierro, España.
authors.forename: Yago
authors.initials: Y
authors.lastname: González-Lama
authors.affiliation: Hospital Universitario Puerta de Hierro Majadahond.
authors.forename: Isabel
authors.initials: I
authors.lastname: Blázquez
authors.affiliation: Hospital Universitario Puerta de Hierro Majadahond.
authors.forename: Cristina J
authors.initials: CJ
authors.lastname: Suárez
authors.affiliation: Hospital Universitario Puerta de Hierro Majadahond.
authors.forename: Borja
authors.initials: B
authors.lastname: Oliva
authors.affiliation: Hospital Universitario Puerta de Hierro Majadahond.
authors.forename: Virginia
authors.initials: V
authors.lastname: Matallana
authors.affiliation: Hospital Universitario Puerta de Hierro Majadahond.
authors.forename: Marta
authors.initials: M
authors.lastname: Calvo
authors.affiliation: Hospital Universitario Puerta de Hierro Majadahond.
authors.forename: Isabel
authors.initials: I
authors.lastname: Vera
authors.affiliation: Hospital Universitario Puerta de Hierro Majadahond.
authors.forename: Luis
authors.initials: L
authors.lastname: Abreu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003113:Colonoscopy; D003131:Combined Modality Therapy; D003424:Crohn Disease / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D012008:Recurrence; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D005765:Gastrointestinal Agents