A survey of current practices used to maintain surgically induced remission following intestinal resection for Crohn's disease.

BACKGROUND AND AIMS: Post-operative Crohn's disease (CD) recurrence is common after intestinal resection. The European Crohn's and Colitis Organization has issued guidelines regarding the optimal post-operative management of patients who have undergone intestinal resection for CD. The current study aims to assess the current adjuvant therapy practices of colorectal surgeons and gastroenterologists.
METHODS: An electronic-based survey was sent to members of the Association of Coloproctology of Great Britain and Ireland and the Irish Society of Gastroenterology.
RESULTS: One hundred twenty-five surgeons and gastroenterologists responded. Gastroenterologists more frequently assessed for pre-clinical recurrence with serum inflammatory markers (97 vs. 51%, P < 0.001), faecal calprotectin (30 vs. 10%, P = 0.008) and ileocolonoscopy (67 vs. 23%, P < 0.001), while surgeons more frequently performed a CT scan (23 vs. 6%, P = 0.037). The majority of respondents estimated the 1-year endoscopic recurrence to be 10-25%, and 36% of respondents offered prophylaxis to all post-operative patients. Budesonide (8 vs. 4%, P = 0.006) and azathioprine/mercaptopurine (60 vs. 33%, P < 0.001) were more often prescribed for high-risk patients, while imidazole antibiotics (11 vs. 5%, P < 0.001) and 5-ASA derivatives were more often prescribed for low-risk patients (51 vs. 14%, P < 0.001).
CONCLUSION: Currently, surgeons and gastroenterologists involved in the peri-operative care of patients with CD underestimate the risk of recurrence following intestinal resection and under-utilize ileocolonoscopy to tailor adjuvant therapy.