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Impact of endoscopic monitoring on postoperative recurrence of Crohnís disease

February's issue Colorectal Disease investigates the impact of endoscopic monitoring and treatment step-up on postoperative recurrence of Crohnís disease.

News image

About 80% of patients with Crohnís disease require surgery, of whom 70% will require a further operation.

Recurrence occurs at the anastomosis.

Although often recommended, the impact of postoperative colonoscopy and treatment adjustment is unknown.

Dr De Cruz and colleagues reviewed patients with a bowel resection over a 10-year period.

The team compared the patients between those who did and did not have a postoperative colonoscopy within 1 year of surgery, and those who did or did not have a step-up in drug therapy.

Of 222 patients operated on, 136 were studied.

24% had a step-up of drug therapy
Colorectal Disease

The doctors noted that of 70 patients with and 66 without postoperative colonoscopy, clinical recurrence occurred in 49% and 48%, and further surgery in 9% and 5%.

The team noted that 89% of colonoscoped patients had a decision based on the colonoscopic findings.

Of these, 24% had a step-up of drug therapy, aminosalicylates, thiopurine, methotrexate, and 76% had no step-up in drug therapy.

The researchers found that in colonoscoped patients clinical recurrence occurred in 9 of 15 patients with, and 23 of 47 without step-up and surgical recurrence in 2 of 15 and 4 of 47.

Dr Cruz's team concluded, "Clinical recurrence occurs in a majority of patients soon after surgery."

"In this cohort, there was no clinical benefit from colonoscopy or increased drug therapy within 1 year after operation."
 
"However, the response to the endoscopic findings was not standardized and immunosuppressive therapy was uncommon. Standardizing timing of colonoscopy and drug therapy, including more intense therapy, may improve outcome, although this remains to be proven." 

Colorectal Dis 2013: 15(2): 187-197
25 February 2013

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