Background: Recurrence of Crohn disease (CD) after an ileo-colonic resection is predicted by the severity of endoscopic lesions during the first year after resection, hence guidelines recommend every patient to underwent endoscopy during the first year after surgery. The aim of our study was to describe the management and results of endoscopy after surgery in a population of CD patients between 2007 and 2010.
Methods: PRACTICROHN was a study that included patients aged ≥18 years-old from 26 Spanish hospitals who underwent CD-related ileocolonic or ileorectal resection with ileocolonic or ileorectal anastomosis between January 2007 and December 2010. Clinical data was retrospectively collected from clinical charts during 5 years follow-up after surgery. Endoscopies were analyzed according to prophylactic treatment prescribed, year of surgery and hospital size. Categorical variables were compared with the χ2 test or Fisher's exact test Kaplan-Meier method was used to assess time to clinical recurrence and a log-ranktest to obtain statistical significance.
Results: 314 patients were analyzed (mean age 40 years [SD 13], 48% men). Of these, 52 (16.6%) had suffered more than one resection before the index surgery. In 143 (46.3%) a colonoscopy was performed during the first year after surgery. In 2007, only 24/75 patients (33%) underwent endoscopy in the first year, while in 2010 endoscopy was performed in 47/79 (59.5%) p=0.017 (Fig. 1).
During first year after surgery, 22 (7%) patients presented with endoscopic recurrence without symptoms. Along the five years follow-up 222 patients underwent colonoscopy. Rutgeerts score was ≥2 in 122 patients (55%). Rutgeerts score in patients that received prophylactic treatment was significantly lower than in patients without prophylaxis (Table 1).
The size of the hospital did not influence the percentage of endoscopies performed, being similar in hospitals <500 beds, between 500 and 900 and in hospitals with more than 900 beds.
Conclusions: From 2007 to 2010 there was a trend towards performing significantly more endoscopies after surgery in CD patients, as recommended by guidelines.
The number of endoscopic recurrence without symptoms in our study reinforces the importance of performing colonoscopies in high risk CD patients.