1. Endoscopy-based management decreases the risk of postoperative recurrences in Crohn's disease
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Anne Dubois, Anthony Buisson, Marion Goutte, Juliette Joubert, Anne-Laure Boucher, Stéphanie Decousus, Michel Dapoigny, Denis Pezet, Felix Goutorbe, Johan Gagnière, Pierre Déchelotte, Corinne Borderon, Gilles Bommelaer, Bruno Pereira, Département Gastroentérologie, CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Université d'Auvergne - Clermont-Ferrand I (UdA), CHU Clermont-Ferrand, Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte (M2iSH), Institut National de la Recherche Agronomique (INRA)-Université d'Auvergne - Clermont-Ferrand I (UdA), Department of Digestive surgery, and ProdInra, Migration more...
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endoscopie ,Male ,Time Factors ,crohn's disease ,Disease ,Kaplan-Meier Estimate ,0302 clinical medicine ,Crohn Disease ,Recurrence ,postoperative recurrence ,risk factors ,Colectomy ,Crohn's disease ,medicine.diagnostic_test ,Gastroenterology ,General Medicine ,Colonoscopy ,Middle Aged ,3. Good health ,facteur de risque ,Treatment Outcome ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Female ,France ,Adult ,Reoperation ,medicine.medical_specialty ,prevalence ,Disease-Free Survival ,03 medical and health sciences ,Young Adult ,Predictive Value of Tests ,medicine ,Humans ,Retrospective Cohort Study ,endoscopy ,Proportional Hazards Models ,Retrospective Studies ,prévalence ,Chi-Square Distribution ,business.industry ,[SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology ,maladie de crohn ,medicine.disease ,digestive system diseases ,[SDV.MHEP.HEG] Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology ,Endoscopy ,Surgery ,Hépatologie et Gastroentérologie ,Multivariate Analysis ,Hépatology and Gastroenterology ,business - Abstract
International audience; AIM: to investigate whether an endoscopy-based management could prevent the long-term risk of postoperative recurrence. METHODS: From the pathology department database, we retrospectively retrieved the data of all the patients operated on for Crohn's disease (CD) in our center (1986-2015). Endoscopy-based management was defined as systematic postoperative colonoscopy (median time after surgery = 9.5 mo) in patients with no clinical postoperative recurrence at the time of endoscopy. RESULTS: From 205 patients who underwent surgery, 161 patients (follow-up > 6 mo) were included. Endoscopic postoperative recurrence occurred in 67.6%, 79.7%, and 95.5% of the patients, respectively 5, 10 and 20 years after surgery. The rate of clinical postoperative recurrence was 61.4%, 75.9%, and 92.5% at 5, 10 and 20 years, respectively. The rate of surgical postoperative recurrence was 19.0%, 38.9% and 64.7%, respectively, 5, 10 and 20 years after surgery. In multivariate analysis, previous intestinal resection, prior exposure to anti-TNF therapy before surgery, and fistulizing phenotype (B3) were postoperative risk factors. Previous perianal abscess/fistula (other perianal lesions excluded), were predictive of only symptomatic recurrence. In multivariate analysis, an endoscopy-based management (n = 49/161) prevented clinical (HR = 0.4, 95% CI: 0.25-0.66, p < 0.001) and surgical postoperative recurrence (HR = 0.30, 95% CI: 0.13-0.70, p = 0.006). CONCLUSION: Endoscopy-based management should be recommended in all CD patients within the first year after surgery as it highly decreases the long-term risk of clinical recurrence and reoperation. more...
- Published
- 2016
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