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Observational Study
. 2024 Aug 14;18(8):1202-1214.
doi: 10.1093/ecco-jcc/jjae011.

Prophylactic Versus Endoscopy-driven Treatment of Crohn's Postoperative Recurrence: A Retrospective, Multicentric, European Study [PORCSE Study]

Jeroen Geldof  1 , Marie Truyens  1 , Michiel Hanssens  1 , Emily Van Gucht  1 , Tom Holvoet  2 , Ainara Elorza  3 , Vincent Bouillon  4 , Sónia Barros  5 , Viviana Martins  5 , Konstantinos Argyriou  6 , Spyridon Potamianos  6 , Mircea Diculescu  7 , Tudor Stroie  7 , Peter Bossuyt  8 , Annick Moens  8 , Eirini Theodoraki  9 , Ioannis E Koutroubakis  9 , Juliana Pedro  10 , Samuel Fernandes  10 , Pinelopi Nikolaou  11 , Konstantinos Karmiris  11 , Filip J Baert  12 , Rocio Ferreiro-Iglesias  13 , Harald Peeters  14 , Sophie Claeys  14 , Maria José Casanova  15 , Piotr Eder  16 , Ross J Porter  17 , Ian Arnott  17 , Tarkan Karakan  18 , Francisco Mesonero  19 , Joana Revés  20 , Evi Van Dyck  21 , Aranzazu Jauregui-Amezaga  22 , Míriam Mañosa  23 , Pauline Rivière  24 , Lucia Marquez Mosquera  25 , Francisco Portela  26 , Raquel Pimentel  26 , Triana Lobaton  1
Affiliations
Observational Study

Prophylactic Versus Endoscopy-driven Treatment of Crohn's Postoperative Recurrence: A Retrospective, Multicentric, European Study [PORCSE Study]

Jeroen Geldof et al. J Crohns Colitis. .

Abstract

Background and aims: No consensus exists on optimal strategy to prevent postoperative recurrence [POR] after ileocaecal resection [ICR] for Crohn's disease [CD]. We compared early medical prophylaxis versus expectant management with treatment driven by findings at elective endoscopy 6-12 months after ICR.

Methods: A retrospective, multicentric, observational study was performed. CD patients undergoing first ICR were assigned to Cohort 1 if a biologic or immunomodulator was [re]started prophylactically after ICR, or to Cohort 2 if no postoperative prophylaxis was given and treatment was started as reaction to elective endoscopic findings. Primary endpoint was rate of endoscopic POR [Rutgeerts >i1]. Secondary endpoints were severe endoscopic POR [Rutgeerts i3/i4], clinical POR, surgical POR, and treatment burden during follow-up.

Results: Of 346 included patients, 47.4% received prophylactic postoperative treatment [proactive/Cohort 1] and 52.6% did not [reactive/Cohort 2]. Endoscopic POR [Rutgeerts >i1] rate was significantly higher in Cohort 2 [41.5% vs 53.8%, OR 1.81, p = 0.039] at endoscopy 6-12 months after surgery. No significant difference in severe endoscopic POR was found [OR 1.29, p = 0.517]. Cohort 2 had significantly higher clinical POR rates [17.7% vs 35.7%, OR 3.05, p = 0.002] and numerically higher surgical recurrence rates [6.7% vs 13.2%, OR 2.59, p = 0.051]. Cox proportional hazards regression analysis showed no significant difference in time to surgical POR of proactive versus expectant/reactive approach [HR 2.50, p = 0.057]. Quasi-Poisson regression revealed a significantly lower treatment burden for immunomodulator use in Cohort 2 [mean ratio 0.53, p = 0.002], but no difference in burden of biologics or combination treatment.

Conclusions: The PORCSE study showed lower rates of endoscopic POR with early postoperative medical treatment compared with expectant management after first ileocaecal resection for Crohn's disease.

Keywords: Crohn’s disease; endoscopy; ileocaecal resection; postoperative recurrence [POR]; surgery.

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