Endoscopy-based management decreases the risk of postoperative recurrences in Crohn's disease.
OBJECTIVE
To investigate whether an endoscopy-based management could prevent the long-term risk of postoperative recurrence.


METHODS
From the pathology department database, we retrospectively retrieved the data of all the patients operated on for Crohn's disease (CD) in our center (1986-2015). Endoscopy-based management was defined as systematic postoperative colonoscopy (median time after surgery = 9.5 mo) in patients with no clinical postoperative recurrence at the time of endoscopy.


RESULTS
From 205 patients who underwent surgery, 161 patients (follow-up > 6 mo) were included. Endoscopic postoperative recurrence occurred in 67.6%, 79.7%, and 95.5% of the patients, respectively 5, 10 and 20 years after surgery. The rate of clinical postoperative recurrence was 61.4%, 75.9%, and 92.5% at 5, 10 and 20 years, respectively. The rate of surgical postoperative recurrence was 19.0%, 38.9% and 64.7%, respectively, 5, 10 and 20 years after surgery. In multivariate analysis, previous intestinal resection, prior exposure to anti-TNF therapy before surgery, and fistulizing phenotype (B3) were postoperative risk factors. Previous perianal abscess/fistula (other perianal lesions excluded), were predictive of only symptomatic recurrence. In multivariate analysis, an endoscopy-based management (n = 49/161) prevented clinical (HR = 0.4, 95%CI: 0.25-0.66, P < 0.001) and surgical postoperative recurrence (HR = 0.30, 95%CI: 0.13-0.70, P = 0.006).


CONCLUSIONS
Endoscopy-based management should be recommended in all CD patients within the first year after surgery as it highly decreases the long-term risk of clinical recurrence and reoperation.
Anne-Laure Boucher, Marion Goutte, Felix Goutorbe, Michel Dapoigny, Gilles Bommelaer, Anthony Buisson, Gastroenterology Department, University Hospital Estaing, 63000 Clermont-Ferrand, France.
Anne-Laure
AL
Boucher
Anne-Laure Boucher, Marion Goutte, Felix Goutorbe, Michel Dapoigny, Gilles Bommelaer, Anthony Buisson, Gastroenterology Department, University Hospital Estaing, 63000 Clermont-Ferrand, France.
Bruno
B
Pereira
Anne-Laure Boucher, Marion Goutte, Felix Goutorbe, Michel Dapoigny, Gilles Bommelaer, Anthony Buisson, Gastroenterology Department, University Hospital Estaing, 63000 Clermont-Ferrand, France.
Stéphanie
S
Decousus
Anne-Laure Boucher, Marion Goutte, Felix Goutorbe, Michel Dapoigny, Gilles Bommelaer, Anthony Buisson, Gastroenterology Department, University Hospital Estaing, 63000 Clermont-Ferrand, France.
Marion
M
Goutte
Anne-Laure Boucher, Marion Goutte, Felix Goutorbe, Michel Dapoigny, Gilles Bommelaer, Anthony Buisson, Gastroenterology Department, University Hospital Estaing, 63000 Clermont-Ferrand, France.
Felix
F
Goutorbe
Anne-Laure Boucher, Marion Goutte, Felix Goutorbe, Michel Dapoigny, Gilles Bommelaer, Anthony Buisson, Gastroenterology Department, University Hospital Estaing, 63000 Clermont-Ferrand, France.
Anne
A
Dubois
Anne-Laure Boucher, Marion Goutte, Felix Goutorbe, Michel Dapoigny, Gilles Bommelaer, Anthony Buisson, Gastroenterology Department, University Hospital Estaing, 63000 Clermont-Ferrand, France.
Johan
J
Gagniere
Anne-Laure Boucher, Marion Goutte, Felix Goutorbe, Michel Dapoigny, Gilles Bommelaer, Anthony Buisson, Gastroenterology Department, University Hospital Estaing, 63000 Clermont-Ferrand, France.
Corinne
C
Borderon
Anne-Laure Boucher, Marion Goutte, Felix Goutorbe, Michel Dapoigny, Gilles Bommelaer, Anthony Buisson, Gastroenterology Department, University Hospital Estaing, 63000 Clermont-Ferrand, France.
Juliette
J
Joubert
Anne-Laure Boucher, Marion Goutte, Felix Goutorbe, Michel Dapoigny, Gilles Bommelaer, Anthony Buisson, Gastroenterology Department, University Hospital Estaing, 63000 Clermont-Ferrand, France.
Denis
D
Pezet
Anne-Laure Boucher, Marion Goutte, Felix Goutorbe, Michel Dapoigny, Gilles Bommelaer, Anthony Buisson, Gastroenterology Department, University Hospital Estaing, 63000 Clermont-Ferrand, France.
Michel
M
Dapoigny
Anne-Laure Boucher, Marion Goutte, Felix Goutorbe, Michel Dapoigny, Gilles Bommelaer, Anthony Buisson, Gastroenterology Department, University Hospital Estaing, 63000 Clermont-Ferrand, France.
Pierre J
PJ
Déchelotte
Anne-Laure Boucher, Marion Goutte, Felix Goutorbe, Michel Dapoigny, Gilles Bommelaer, Anthony Buisson, Gastroenterology Department, University Hospital Estaing, 63000 Clermont-Ferrand, France.
Gilles
G
Bommelaer
Anne-Laure Boucher, Marion Goutte, Felix Goutorbe, Michel Dapoigny, Gilles Bommelaer, Anthony Buisson, Gastroenterology Department, University Hospital Estaing, 63000 Clermont-Ferrand, France.
Anthony
A
Buisson
D000328:Adult; D016009:Chi-Square Distribution; D003082:Colectomy / Q000009:adverse effects; D003113:Colonoscopy; D003424:Crohn Disease / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005602:France; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
Crohn’s disease; Endoscopy; Postoperative recurrence; Prevalence; Risk factors