Clinical Predictors of Early and Late Endoscopic Recurrence Following Ileocolonic Resection in Crohn's Disease

J Crohns Colitis. 2024 Apr 23;18(4):615-627. doi: 10.1093/ecco-jcc/jjad186.

Abstract

Background and aims: Multiple factors are suggested to place Crohn's disease patients at risk of recurrence after ileocolic resection with conflicting associations. We aimed to identify clinical predictors of recurrence at first [early] and further [late] postoperative colonoscopy.

Methods: Crohn's disease patients undergoing ileocolic resection were prospectively recruited at six North American centres. Clinical data were collected and endoscopic recurrence was defined as Rutgeerts score ≥i2. A multivariable model was fitted to analyse variables independently associated with recurrence.

Results: A total of 365 patients undergoing 674 postoperative colonoscopies were included with a median age of 32 years, 189 [51.8%] were male, and 37 [10.1%] were non-Whites. Postoperatively, 133 [36.4%] used anti-tumour necrosis factor [anti-TNF] and 30 [8.2%] were smokers. At first colonoscopy, 109 [29.9%] had recurrence. Male gender (odds ratio [OR] = 1.95, 95% confidence interval [CI] 1.12-3.40), non-White ethnicity [OR = 2.48, 95% CI 1.09-5.63], longer interval between surgery and colonoscopy [OR = 1.09, 95% CI 1.002-1.18], and postoperative smoking [OR = 2.78, 95% CI 1.16-6.67] were associated with recurrence, while prophylactic anti-TNF reduced the risk [OR = 0.28, 95% CI 0.14-0.55]. Postoperative anti-TNF prophylaxis had a protective effect on anti-TNF experienced patients but not on anti-TNF naïve patients. Among patients without recurrence at first colonoscopy, Rutgeerts score i1 was associated with subsequent recurrence [OR = 4.43, 95% CI 1.73-11.35].

Conclusions: We identified independent clinical predictors of early and late Crohn's disease postoperative endoscopic recurrence. Clinical factors traditionally used for risk stratification failed to predict recurrence and need to be revised.

Keywords: Crohn’s disease; postoperative recurrence; risk factors.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Colectomy / methods
  • Colon / pathology
  • Colon / surgery
  • Colonoscopy* / methods
  • Colonoscopy* / statistics & numerical data
  • Crohn Disease* / surgery
  • Female
  • Humans
  • Ileum* / pathology
  • Ileum* / surgery
  • Male
  • Middle Aged
  • Prospective Studies
  • Recurrence*
  • Risk Factors
  • Sex Factors
  • Smoking / adverse effects
  • Smoking / epidemiology
  • Time Factors