Gabriele Dragoni1,2, Nik Ding3, Krisztina B Gecse4, John C Mansfield5, Uri Kopylov6, Laurent Beaugerie7, Peter Bossuyt8, Shaji Sebastian9, Monica Milla1, Siro Bagnoli1, Nuha A Yassin10, Dominik Bettenworth11, Johan Burisch12, Charlotte Hedin13, Javier P Gisbert14, Marc Ferrante2. 1. Department of Gastroenterology, IBD Referral Center, AOU Careggi Hospital, Florence, Italy. 2. Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium. 3. Department of Gastroenterology, St. Vincent, Melbourne, Australia. 4. Department of Gastroenterology and Hepatology, Location AMC, Amsterdam University Medical Center, Amsterdam, the Netherlands. 5. Institute of Genetic Medicine, Royal Victoria Infirmary, Newcastle upon Tyne, UK. 6. Department of Gastroenterology, Sheba Medical Center, Ramat Gan, and Sackler School of Medicine, Israel. 7. Department of Gastroenterology, Sorbonne Université, AP-HP, Hôpital Saint-Antoine, Paris, France. 8. Department of Gastroenterology, Imelda General Hospital, Bonheiden, Belgium. 9. IBD Unit, Hull University Teaching Hospitals NHS Trust, Hull, UK. 10. Department of Colorectal Surgery, St Mark's Hospital, London, UK. 11. Department of Medicine B, Gastroenterology and Hepatology, University Hospital Münster, Münster, Germany. 12. Gastrounit, Medical Section, Hvidovre University Hospital, Gastrounit, Hvidovre, Denmark. 13. Department of Gastroenterology and Hepatology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden. 14. Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
Abstract
BACKGROUND: Prevention and management of postoperative recurrence (POR) is a controversial field in Crohn's disease. The aim of this survey was to report common practice in real-life settings. METHODS: An 11-question survey was distributed among gastroenterologists attending the 14th European Crohn's and Colitis Organisation (ECCO) congress. RESULTS: Postoperative endoscopy to assess recurrence was routinely performed within 12 months by 87% of respondents. Forty-six percent of clinicians reported to maintain endoscopic assessment in routine follow-up even after first negative colonoscopy. Most respondents (60%) considered starting postoperative immunoprophylaxis in naïve patients if one or more known risk factors were present. The number of risk factors was an important driver for prescribing biologics over immunosuppressants for 60% of respondents.In case of fistulizing phenotype, perianal disease, or concomitant colonic involvement, the majority of physicians reported to start an immediate prophylaxis in 85, 98 and 88% of patients, respectively. A significant percentage of clinicians were more prone to an endoscopy-driven treatment in long-standing disease after failure of thiopurines (51%) and elderly (43%). CONCLUSION: Endoscopy within the first year after surgery to assess POR has become routine in most centres. The high rate of early prophylaxis with expensive biologics despite missing solid evidence highlights the need for more randomized trials.
BACKGROUND: Prevention and management of postoperative recurrence (POR) is a controversial field in Crohn's disease. The aim of this survey was to report common practice in real-life settings. METHODS: An 11-question survey was distributed among gastroenterologists attending the 14th European Crohn's and Colitis Organisation (ECCO) congress. RESULTS: Postoperative endoscopy to assess recurrence was routinely performed within 12 months by 87% of respondents. Forty-six percent of clinicians reported to maintain endoscopic assessment in routine follow-up even after first negative colonoscopy. Most respondents (60%) considered starting postoperative immunoprophylaxis in naïve patients if one or more known risk factors were present. The number of risk factors was an important driver for prescribing biologics over immunosuppressants for 60% of respondents.In case of fistulizing phenotype, perianal disease, or concomitant colonic involvement, the majority of physicians reported to start an immediate prophylaxis in 85, 98 and 88% of patients, respectively. A significant percentage of clinicians were more prone to an endoscopy-driven treatment in long-standing disease after failure of thiopurines (51%) and elderly (43%). CONCLUSION: Endoscopy within the first year after surgery to assess POR has become routine in most centres. The high rate of early prophylaxis with expensive biologics despite missing solid evidence highlights the need for more randomized trials.