title: Rates and Predictors of Endoscopic and Clinical Recurrence After Primary Ileocolic Resection for Crohn's Disease.
abstract: The utility of postoperative medical prophylaxis (POMP) and the treatment of mild endoscopic recurrence remain controversial.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors: University of Toronto, Toronto, Canada. kyle.fortinsky@mail.utoronto.ca.
authors: Kyle Joshua
authors: KJ
authors: Fortinsky
authors: University of Toronto, Toronto, Canada.
authors: David
authors: D
authors: Kevans
authors: University of Toronto, Toronto, Canada.
authors: Judy
authors: J
authors: Qiang
authors: University of Toronto, Toronto, Canada.
authors: Wei
authors: W
authors: Xu
authors: University of Toronto, Toronto, Canada.
authors: Felipe
authors: F
authors: Bellolio
authors: University of Toronto, Toronto, Canada.
authors: Hillary
authors: H
authors: Steinhart
authors: University of Toronto, Toronto, Canada.
authors: Raquel
authors: R
authors: Milgrom
authors: University of Toronto, Toronto, Canada.
authors: Gordon
authors: G
authors: Greenberg
authors: University of Toronto, Toronto, Canada.
authors: Zane
authors: Z
authors: Cohen
authors: University of Toronto, Toronto, Canada.
authors: Helen
authors: H
authors: Macrae
authors: University of Toronto, Toronto, Canada.
authors: Joanne
authors: J
authors: Stempak
authors: University of Toronto, Toronto, Canada.
authors: Robin
authors: R
authors: McLeod
authors: University of Toronto, Toronto, Canada.
authors: Mark S
authors: MS
authors: Silverberg
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000367:Age Factors; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D003082:Colectomy; D003106:Colon / Q000601:surgery; D003424:Crohn Disease / Q000175:diagnosis / Q000517:prevention & control / Q000601:surgery*; D016145:Endoscopy, Digestive System; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000601:surgery; D007155:Immunologic Factors / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D008297:Male; D019804:Mesalamine / Q000627:therapeutic use; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods*; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D055502:Secondary Prevention / Q000379:methods*
chemical_list: D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D007155:Immunologic Factors; D019804:Mesalamine
keywords: Clinical recurrence; Endoscopic recurrence; Endoscopy; Postoperative prophylaxis; Quality of life; Socio-economical and psychological endpoints; Surgery