Endoscopic Evaluation at One Month After Ileocolic Resection for Crohn's Disease Predicts Future Postoperative Recurrence and Is Safe.

Background Endoscopy remains the gold standard for evaluating postoperative recurrence in Crohn's disease (CD). Timely therapy adjustment according to the endoscopic findings can improve long term outcomes. Objective We aimed to determine the characteristics, clinical values, and safety of the endoscopic evaluation at one month after surgery. Design This was a prospective observational study. Settings This study was conducted in a tertiary referral hospital. Patients CD patients undergoing ileocolic resection between Jan 2016 and Nov 2018 were included. Interventions The first postoperative ileocolonoscopy was performed at 4-5 week after surgery. Main outcome measures The primary outcome was postoperative recurrence within 12 months after surgery. Univariate and multivariate analyses were performed to identify risk factors. Results Among 84 ileocolonoscopies at 4-5 week, no endoscopic complication occurred. The main endoscopic findings at the first evaluation were anastomotic circumferential ulcers(10, 11.9%), anastomotic scattered ulcers(35, 41.7%), ulcers in the neo-terminal ileum (16, 19.0%), edema in anastomosis (50, 59.5%), mild narrowing in anastomosis (7, 8.3%), and mild narrowing in neo-terminal ileum (3, 3.6%). Anastomotic scattered ulcers were associated with future postoperative recurrence (OR,2.532[1.02-6.32], p=0.046). Fecal calprotectin on post d 14>150ug/g could predict anastomotic scattered ulcers(OR 2.91[1.31-7.47], p=0.027). The modified Rutgeerts score was used to define endoscopic findings: i0, 37(44.0%); i1, 4(4.8%); i2a, 29(34.5%); i2b, 11(13.1%); i3, 0; i4, 3(3.6%). Score ≥i2a were associated with future postoperative recurrence (OR,3.17 [1.22-8.27], p=0.018). No factor was associated with ≥i2a at the first endoscopy. Limitations This was a single-center study with a small cohort of patients. Conclusions Endoscopic evaluation at one month after surgery in CD was safe. Anastomotic scattered ulcers occurred in nearly half of patients and were associated with future postoperative recurrence. See Video Abstract at http://links.lww.com/DCR/B760.