title: Factors affecting the incidence of early endoscopic recurrence after ileocolonic resection for Crohn's disease: a multicentre observational study.
abstract: OBJECTIVE
  Early endoscopic recurrence is frequently observed in patients following resection for Crohn's disease (CD). However, factors affecting the incidence of an early postoperative endoscopic recurrence (EPER) have not been fully determined. The aim of this study was to evaluate risk factors for EPER after ileocolonic resection for CD.
  
  
  METHODS
  This was a retrospective, international multicentre study, in which 127 patients with a first ileocolonoscopy conducted between 6 and 12 months after ileocolonic resection for CD were included. Endoscopic recurrence was defined as a Rutgeerts score of ≥ i2. The following variables were investigated as potential risk factors for EPER: gender, age at surgery, location and behaviour of CD, smoking, concomitant perianal lesions, preoperative use of steroids, immunomodulators and biologics, previous resection, blood transfusion, surgical procedure (open vs laparoscopic approach), length of resected bowel, type of anastomosis (side-to-side vs end-to-end), postoperative complications, granuloma and postoperative biological therapy. Variables related to the patient, disease and surgical procedure were investigated as potential risk factors for EPER, with univariate and multivariate (logistic regression) analyses.
  
  
  RESULTS
  43/127 (34%) patients had EPER at the time of the first postoperative ileocolonoscopy. In univariate analysis, only preoperative steroid use was significantly associated with a higher rate of EPER [21/45 patients (47%) on steroids and 22/82 patients (27%) without steroids (P = 0.04)]. In multivariate analysis, only preoperative steroid use was a significant independent risk factor for EPER (odds ratio 3.28, 95% confidence interval: 1.30-8.28; P = 0.01).
  
  
  CONCLUSIONS
  This study found that only preoperative steroid use was a significant risk factor for EPER after ileocolonic resection for CD. Prospective studies are necessary to evaluate precisely the impact of perioperative medications on EPER rates.
authors.affiliation: Colorectal Surgery Unit, Cajuru University Hospital, Catholic University of Paraná, Curitiba, Brazil.
authors.forename: I F
authors.initials: IF
authors.lastname: de Barcelos
authors.affiliation: Colorectal Surgery Unit, Cajuru University Hospital, Catholic University of Paraná, Curitiba, Brazil.
authors.forename: P G
authors.initials: PG
authors.lastname: Kotze
authors.affiliation: Colorectal Surgery Unit, Humanitas Research Hospital, Milano, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Spinelli
authors.affiliation: Gastroenterology Unit, Toho University Sakura Medical Centre, Chiba, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Suzuki
authors.affiliation: Gastrosaude Outpatient Clinic, Marilia, Brazil.
authors.forename: F V
authors.initials: FV
authors.lastname: Teixeira
authors.affiliation: IBD Unit, Heliopolis Hospital, Sao Paulo, Brazil.
authors.forename: I C
authors.initials: IC
authors.lastname: de Albuquerque
authors.affiliation: Digestive Surgery Department, Sao Paulo State University (UNESP), Botucatu, Brazil.
authors.forename: R
authors.initials: R
authors.lastname: Saad-Hossne
authors.affiliation: Colorectal Surgery Unit, Cajuru University Hospital, Catholic University of Paraná, Curitiba, Brazil.
authors.forename: L M
authors.initials: LM
authors.lastname: da Silva Kotze
authors.affiliation: IBD Centre, Yokkaichi Hazu Medical Centre, Yokkaichi, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Yamamoto
mesh_terms: D000293:Adolescent; D000328:Adult; D003082:Colectomy / Q000009:adverse effects* / Q000379:methods; D003106:Colon / Q000601:surgery; D003113:Colonoscopy / Q000379:methods / Q000706:statistics & numerical data*; D003424:Crohn Disease / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery; D015994:Incidence; D016015:Logistic Models; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D057234:Preoperative Period; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013256:Steroids / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D013256:Steroids
keywords: Crohn's disease; endoscopic recurrence; ileocolonic resection; postoperative recurrence; risk factor