Importance of early endoscopic surveillance for postoperative Crohn's disease patients

Prevention of postoperative recurrence is a crucial issue to avoid repeated surgery and subsequent complications in Crohn's disease (CD) patients, however therapeutic strategy for postoperative patients has not been established. In the present study we aimed to investigate the importance of early endoscopic surveillance after surgery. This is a single-center retrospective analysis from a prospectively collected database. Twenty-five consecutive CD patients who underwent resection for ileal or ileocolic lesion and received follow-up endoscopy within 2 years were enrolled. The mean age at surgery was 40.1 years (range 20-62) and all patients received colonoscopy or double balloon endoscopy in an average of 339 days after surgery. Fourteen patients (56.0%) received anti-TNF maintenance therapy. When endoscopic remission is defined as Rutgeerts score of i0 or i1, overall endoscopic remission rate was 84.0% (21/25). Among patients with endoscopic remission, CRP levels and CDAI scores at the time point of endoscopy were not significantly different between i0 and i1 groups; however, sustained serological remission (below 0.2mg/dl of CRP at 2 years after surgery) rate in i1 group was 37.5% which was significantly lower than i0 group of 90.9%. In conclusion, early endoscopic surveillance to identify patients with mild activity (i1) is helpful to evaluate postoperative recurrence.