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©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
Endoscopy-based management decreases the risk of postoperative recurrences in Crohn’s disease
Anne-Laure Boucher, Bruno Pereira, Stéphanie Decousus, Marion Goutte, Felix Goutorbe, Anne Dubois, Johan Gagniere, Corinne Borderon, Juliette Joubert, Denis Pezet, Michel Dapoigny, Pierre J Déchelotte, Gilles Bommelaer, Anthony Buisson
Anne-Laure Boucher, Marion Goutte, Felix Goutorbe, Michel Dapoigny, Gilles Bommelaer, Anthony Buisson, Gastroenterology Department, University Hospital Estaing, 63000 Clermont-Ferrand, France
Bruno Pereira, DRCI, Biostatistics Unit, GM Clermont-Ferrand University and Medical Center, 63000 Clermont-Ferrand, France
Stéphanie Decousus, Juliette Joubert, Pierre J Déchelotte, Pathology Department, University Hospital Estaing, 63000 Clermont-Ferrand, France
Marion Goutte, Gilles Bommelaer, Anthony Buisson, Microbes, Intestine, Inflammation and Susceptibility of the Host, UMR 1071 Inserm/Université d’Auvergne; USC-INRA 2018, 63000 Clermont-Ferrand, France
Anne Dubois, Johan Gagniere, Denis Pezet, Digestive Surgery Department, University Hospital Estaing, 63000 Clermont-Ferrand, France
Corinne Borderon, Pediatrics Department, University Hospital Estaing, 63000 Clermont-Ferrand, France
Author contributions: All the authors equally contributed to this paper.
Institutional review board statement: The study was approved by local Ethics Committee (IRB number 00008526 - 2014/CE86).
Informed consent statement: The study was performed in accordance with the Declaration of Helsinki, Good Clinical Practice and applicable regulatory requirements.
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at a_buisson@hotmail.fr.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Anthony Buisson, MD, Gastroenterology Department, University Hospital Estaing, 1, place Lucie et Raymond Aubrac, 63003 Clermont-Ferrand, France. a_buisson@hotmail.fr
Telephone: +33-4-73750523 Fax: +33-4-73750524
Received: February 24, 2016
Peer-review started: February 26, 2016
First decision: March 31, 2016
Revised: April 14, 2016
Accepted: April 20, 2016
Article in press: April 20, 2016
Published online: June 7, 2016
AIM: To investigate whether an endoscopy-based management could prevent the long-term risk of postoperative recurrence.
METHODS: From the pathology department database, we retrospectively retrieved the data of all the patients operated on for Crohn’s disease (CD) in our center (1986-2015). Endoscopy-based management was defined as systematic postoperative colonoscopy (median time after surgery = 9.5 mo) in patients with no clinical postoperative recurrence at the time of endoscopy.
RESULTS: From 205 patients who underwent surgery, 161 patients (follow-up > 6 mo) were included. Endoscopic postoperative recurrence occurred in 67.6%, 79.7%, and 95.5% of the patients, respectively 5, 10 and 20 years after surgery. The rate of clinical postoperative recurrence was 61.4%, 75.9%, and 92.5% at 5, 10 and 20 years, respectively. The rate of surgical postoperative recurrence was 19.0%, 38.9% and 64.7%, respectively, 5, 10 and 20 years after surgery. In multivariate analysis, previous intestinal resection, prior exposure to anti-TNF therapy before surgery, and fistulizing phenotype (B3) were postoperative risk factors. Previous perianal abscess/fistula (other perianal lesions excluded), were predictive of only symptomatic recurrence. In multivariate analysis, an endoscopy-based management (n = 49/161) prevented clinical (HR = 0.4, 95%CI: 0.25-0.66, P < 0.001) and surgical postoperative recurrence (HR = 0.30, 95%CI: 0.13-0.70, P = 0.006).
CONCLUSION: Endoscopy-based management should be recommended in all CD patients within the first year after surgery as it highly decreases the long-term risk of clinical recurrence and reoperation.
Core tip: Although often recommended, the impact of an endoscopy-based management following surgery remains poorly investigated in Crohn’s patients. We aimed to investigate whether an endoscopy-based management could prevent the long-term risk of postoperative recurrence in Crohn’s disease (CD). We retrospectively retrieved the data of 161 patients operated on for CD in our center. We showed for the first time, that an endoscopy-based management decreased the long-term risk of clinical and surgical postoperative recurrence in CD and the risk of reoperation.
