IBD Referral Center, Department of Gastroenterology, Careggi University Hospital, Florence, Italy.
Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy.
United European Gastroenterol J. 2023 Apr;11(3):271-281. doi: 10.1002/ueg2.12367. Epub 2023 Mar 21.
The management of postoperative recurrence (POR) in Crohn's disease (CD) after ileo-colonic resection is a highly debated topic. Prophylactic immunosuppression after surgery is currently recommended in the presence of at least one clinical risk factor.
Our aim was to determine whether early immunosuppression can be avoided and guided by endoscopy in CD patients with only one risk factor.
CD patients with only one risk factor for POR, including previous intestinal resection, extensive small intestine resection (>50 cm), fistulising phenotype, history of perianal disease, and active smoking, were retrospectively included. Two groups were formed based on whether immunosuppression was started immediately after surgery ("prophylaxis group") or guided by endoscopy ("endoscopy-driven group"). Primary endpoints were rates of any endoscopic recurrence (Rutgeerts ≥ i2a) and severe endoscopic recurrence (i4) within 12 months after surgery. Secondary outcomes were clinical recurrence rates at 6, 12 and 24 months after surgery.
A total of 195 patients were enroled, of whom 61 (31.3%) received immunoprophylaxis. No differences between immunoprophylaxis and the endoscopy-driven approach were found regarding any endoscopic recurrence (36.1% vs. 45.5%, respectively, p = 0.10) and severe endoscopic recurrence (9.8% vs. 15.7%, respectively, p = 0.15) at the first endoscopic evaluation. Clinical recurrence rates were also not statistically different (p = 0.43, p = 0.09, and p = 0.63 at 6, 12, and 24 months, respectively).
In operated CD patients with only one risk factor for POR, immediate immunoprophylaxis does not decrease the rate of early clinical and endoscopic recurrence. Prospective studies are needed to confirm our results.
回肠结肠切除术后克罗恩病（CD）的术后复发（POR）的管理是一个备受争议的话题。目前，在存在至少一个临床危险因素的情况下，建议在手术后进行预防性免疫抑制。
我们的目的是确定在仅存在一个 POR 危险因素的 CD 患者中，是否可以通过内镜避免并指导早期免疫抑制。
回顾性纳入仅存在 POR 一个危险因素的 CD 患者，包括既往肠切除术、广泛小肠切除术（>50cm）、瘘管形成表型、肛周疾病史和吸烟史。根据手术后是否立即开始免疫抑制（“预防组”）或内镜指导（“内镜驱动组”）将患者分为两组。主要终点是手术后 12 个月内任何内镜复发（Rutgeerts≥i2a）和严重内镜复发（i4）的发生率。次要结局是手术后 6、12 和 24 个月的临床复发率。
共纳入 195 例患者，其中 61 例（31.3%）接受了免疫预防。在任何内镜复发（分别为 36.1%和 45.5%，p=0.10）和严重内镜复发（分别为 9.8%和 15.7%，p=0.15）方面，免疫预防与内镜驱动方法之间无差异在第一次内镜评估时。临床复发率也无统计学差异（p=0.43、p=0.09 和 p=0.63，分别在 6、12 和 24 个月时）。
在仅存在 POR 一个危险因素的手术 CD 患者中，立即进行免疫预防并不能降低早期临床和内镜复发的发生率。需要前瞻性研究来证实我们的结果。
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