Natural History and Risk Stratification of Recurrent Crohn's Disease after Ileocolonic Resection: A Multicenter Retrospective Cohort Study

Background: Prediction of endoscopic postoperative recurrence (POR) and prophylactic treatment based on clinical risk profile have thus far been inconclusive. This study aimed to examine the association between clinical risk profile and the development of endoscopic POR in a Crohn's disease population without postoperative treatment and to identify individual risk factors of endoscopic POR. Methods: Medical records of 142 patients with Crohn's disease during follow-up after ileocecal or ileocolonic resection without prophylactic treatment at 3 referral centers were reviewed. Endoscopic POR was defined as a modified Rutgeerts score ≥i2b. Clinical risk profiles were distilled from current guidelines. Both uni-and multivariate logistic regression analysis were used to assess the relationship between risk profiles and endoscopic POR. Results: Endoscopic POR was observed in 68 out of 142 (47.9%) patients. Active smoking postsurgery (odds ratio [OR], 3.01; 95% confidence interval [CI], 1.24-7.34; P=0.02), a Montreal classification of A3 (OR, 3.05; 95% CI, 1.07-8.69; P=0.04), and previous bowel resections (OR, 2.58; 95% CI, 1.07-6.22; P=0.03) were significantly associated with endoscopic POR. No significant association was observed between endoscopic POR and any guideline defined as a high-/low-risk profile. However, patients with a combination of any 3 or more European Crohns & Colitis Organisation-(OR, 4.87; 95% CI, 1.30-18.29; P=0.02) or British Society of Gastroenterology-defined (OR 3.16; 95% CI, 1.05-9.49; P=0.04) risk factors showed increased odds of developing endoscopic POR. Conclusions: Our results suggest that patients with a combination of any 3 or more European Crohns & Colitis Organisation-or British Society of Gastroenterology-defined risk factors would probably benefit from immediate prophylactic treatment.