Tang Shasha, Liu Wei, Qi Weilin, Yu Tunan, Cao Qian, Ge Xiaolong, Zhou Wei
Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Inflammatory Bowel Disease Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Gastroenterol Res Pract. 2020 Apr 20;2020:8618574. doi: 10.1155/2020/8618574. eCollection 2020.
Postoperative endoscopic recurrence (PER) is common in patients with Crohn's disease (CD) after surgery. The impact of the American Gastroenterological Association (AGA) guideline adherence on PER in real life remains unclear.
The postoperative management of CD patients undergoing ileocolonic resection with anastomosis from 2017 to 2018 was conducted based on the AGA guidelines. Colonoscopies were performed within one year after surgery. Clinical data and risk factors for endoscopic recurrence were analyzed focusing on postoperative pharmacological prophylaxis.
All patients were at a high risk of postoperative recurrence according to the AGA guidelines. PER occurred in 29 (28.7%) of these patients. The overall PER rate was 39.2% at one year. The PER rate in patients treated with nitroimidazole, thiopurines, infliximab, or a combination of thiopurines and infliximab for postoperative prophylaxis was 88.1%, 34.1%, 20.5%, and 0%, respectively. Cox regression showed that smoking at the time of surgery and AGA guideline adherence were independent factors associated with PER (HR: 3.75, 95% CI: 1.36-10.33, = 0.01; HR: 0.36, 95% CI: 0.15-0.86, = 0.02). In addition, further investigation revealed that educational background was the main factor related to patients' nonadherence to AGA guidelines.
The majority of CD patients who undergo surgery in clinical practice may be at a high risk of disease recurrence. Thiopurines and infliximab are effective in preventing endoscopic recurrence. Guideline nonadherence is associated with PER at one year, thus indicating that there is room for improvement in adherence to the AGA guidelines.
术后内镜复发（PER）在克罗恩病（CD）患者术后很常见。美国胃肠病学会（AGA）指南的依从性对现实生活中PER的影响尚不清楚。
2017年至2018年对接受回结肠切除吻合术的CD患者进行术后管理，依据AGA指南进行。术后一年内进行结肠镜检查。重点分析临床数据及内镜复发的危险因素，尤其关注术后药物预防情况。
根据AGA指南，所有患者术后复发风险均高。其中29例（28.7%）出现PER。一年时总体PER率为39.2%。术后预防使用硝基咪唑、硫唑嘌呤、英夫利昔单抗或硫唑嘌呤与英夫利昔单抗联合治疗的患者，其PER率分别为88.1%、34.1%、20.5%和0%。Cox回归显示，手术时吸烟和AGA指南依从性是与PER相关的独立因素（风险比：3.75，95%置信区间：1.36 - 10.33，P = 0.01；风险比：0.36，95%置信区间：0.15 - 0.86，P = 0.02）。此外，进一步调查发现教育背景是患者不依从AGA指南的主要因素。
临床实践中接受手术的大多数CD患者疾病复发风险可能较高。硫唑嘌呤和英夫利昔单抗对预防内镜复发有效。不依从指南与一年时的PER相关，这表明在依从AGA指南方面仍有改进空间。
