Recomendaciones del Grupo Español de Trabajo en Enfermedad de Crohn y Colitis Ulcerosa (GETECCU) sobre la monitorización, prevención y tratamiento de la recurrencia posquirúrgica en la enfermedad de Crohn

Antitumor Necrosis Factor Agents to Treat Endoscopic Postoperative Recurrence of Crohn's Disease: A Nationwide Study With Propensity-Matched Score Analysis

“…Anyway, preventive thiopurine therapy for POR, and exposure to thiopurines or anti-TNF agents before the index surgery, were not associated with a lower efficacy of anti-TNF therapy once POR occurred. Another reason for the delay in starting anti-TNF agents could have been the fact that treatment escalation for POR in Spain is advised only for advanced endoscopic POR ( 8 ); for that matter, almost two-thirds of our patients had advanced endoscopic POR at the index ileocolonoscopy, whereas most of early endoscopic POR correspond to i2 in reported series ( 13 , 20 ).…”

“…Current guidelines on the postoperative management of CD recommend the primary prevention of POR in all patients except those with pure fibrotic and short ileal stenosis ( 8 , 9 ). However, the need for systematic primary prophylaxis for POR is under debate, with some authors posing the use of an endoscopic-driven strategy in which only those patients showing mucosal lesions would be treated ( 6 ).…”

“…The fact that mucosal lesions (as assessed by ileocolonoscopy and called endoscopic POR) occur early after surgery and always precede the development of symptoms (clinical POR) ( 4 ), and the existence of a fine correlation between their severity and the likeliness of developing clinical POR ( 3 ), are the main arguments for advising early endoscopic monitoring in these patients, regardless of the fact that preventive therapy has been initiated ( 7 – 9 ). In the absence of lesions or in cases of mild mucosal lesions, some guidelines recommend a conservative attitude, together with a close monitoring with noninvasive diagnostic tools afterward ( 8 , 10 ). By contrast, if severe lesions are noticed in this endoscopic assessment, treatment escalation is strongly recommended ( 8 , 9 ).…”

“…In the absence of lesions or in cases of mild mucosal lesions, some guidelines recommend a conservative attitude, together with a close monitoring with noninvasive diagnostic tools afterward ( 8 , 10 ). By contrast, if severe lesions are noticed in this endoscopic assessment, treatment escalation is strongly recommended ( 8 , 9 ).…”

Pathophysiology of Crohn’s disease inflammation and recurrence

“…The presence of microscopic lesion, detected during endoscopic examinations 1 year after surgery, reinforces their role as precursors of POR. Timing of endoscopic surveillance has been discussed taking into account available evidence; recommendation is to perform endoscopic examination after 6 months from surgery or within the first year [ 64 , 65 ]. Other techniques have been investigated to assess POR [ 66 ]; in particular, there is a great interest in non-invasive techniques such as ultrasonography (US).…”