Department of Internal Medicine, NYU Grossman School of Medicine, New York University Langone Health, 550 First Avenue, New York, NY, USA.
Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Dig Dis Sci. 2023 Sep;68(9):3596-3604. doi: 10.1007/s10620-023-08044-7. Epub 2023 Aug 7.
Crohn's disease recurrence after ileocecal resection is common. Guidelines suggest colonoscopy within 6-12 months of surgery to assess for post-operative recurrence, but use of adjunctive monitoring is not protocolized. We aimed to describe the state of monitoring in post-operative Crohn's.
We conducted a retrospective study of patients with Crohn's after ileocolic resection with ≥ 1-year follow-up. Patients were stratified into high and low risk based on guidelines. Post-operative biomarker (C-reactive protein, fecal calprotectin), cross-sectional imaging, and colonoscopy use were assessed. Biomarker, radiographic, and endoscopic post-operative recurrence were defined as elevated CRP/calprotectin, active inflammation on imaging, and Rutgeerts ≥ i2b, respectively. Data were stratified by surgery year to assess changes in practice patterns over time. P-values were calculated using Wilcoxon test and Fisher exact test.
Of 901 patients, 53% were female and 78% high risk. Median follow-up time was 60 m for LR and 50 m for high risk. Postoperatively, 18% low and 38% high risk had CRPs, 5% low and 10% high risk had calprotectins, and half of low and high risk had cross-sectional imaging. 29% low and 38% high risk had colonoscopy by 1 year. Compared to pre-2015, time to first radiography (584 days vs. 398 days) and colonoscopy (421 days vs. 296 days) were significantly shorter for high-risk post-2015 (P < 0.001). Probability of colonoscopy within 1 year increased over time (0.48, 2011 vs. 0.92, 2019).
Post-operative colonoscopy completion by 1 year is low. The use of CRP and imaging are common, whereas calprotectin is infrequently utilized. Practice patterns are shifting toward earlier monitoring.
回肠切除术治疗后克罗恩病的复发很常见。指南建议在手术后 6-12 个月内进行结肠镜检查以评估术后复发情况，但未将辅助监测纳入方案。我们旨在描述术后克罗恩病的监测状态。
我们对回肠结肠切除术后有≥1 年随访的克罗恩病患者进行了回顾性研究。患者根据指南分为高风险和低风险。评估术后生物标志物（C 反应蛋白、粪便钙卫蛋白）、横断面成像和结肠镜检查的使用情况。将生物标志物、影像学和内镜下术后复发定义为 CRP/钙卫蛋白升高、影像学上有活动炎症和 Rutgeerts≥i2b。数据按手术年份进行分层，以评估随时间推移实践模式的变化。使用 Wilcoxon 检验和 Fisher 确切检验计算 P 值。
在 901 名患者中，53%为女性，78%为高风险。LR 的中位随访时间为 60m，高风险的为 50m。术后，18%的低风险和 38%的高风险患者 CRP 升高，5%的低风险和 10%的高风险患者钙卫蛋白升高，一半的低风险和高风险患者进行了横断面成像。1 年内，29%的低风险和 38%的高风险患者进行了结肠镜检查。与 2015 年前相比，高风险患者的首次影像学检查（584 天比 398 天）和结肠镜检查（421 天比 296 天）的时间明显缩短（P<0.001）。1 年内进行结肠镜检查的概率随时间增加（2011 年为 0.48，2019 年为 0.92）。
1 年内完成结肠镜检查的比例较低。CRP 和影像学的应用较为常见，而钙卫蛋白的应用则较少。实践模式正在向早期监测转变。
