• Kyle Joshua Fortinsky, David Kevans, Judy Qiang, Wei Xu, Felipe Bellolio, Hillary Steinhart, Raquel Milgrom, Gordon Greenberg, Zane Cohen, Helen Macrae, Joanne Stempak, Robin McLeod, and Mark S Silverberg.
• University of Toronto, Toronto, Canada. kyle.fortinsky@mail.utoronto.ca.
• Dig. Dis. Sci. 2017 Jan 1; 62 (1): 188-196.

Background And AimsThe utility of postoperative medical prophylaxis (POMP) and the treatment of mild endoscopic recurrence remain controversial.MethodsThis study is a retrospective review of patients undergoing a primary ileocolic resection for CD at a single academic center. Endoscopic recurrence (ER) was defined using the Rutgeerts score (RS), and clinical recurrence (CR) was defined as symptoms of CD with endoscopic or radiologic evidence of neo-terminal ileal disease.ResultsThere were 171 patients who met inclusion criteria. The cumulative probability of ER (RS ≥ i-1) at 1, 2, and 5 years was 29, 51, and 77 %, respectively. The only independent predictors of ER were the absence of POMP (HR 1.50; P = 0.03) and penetrating disease behavior (HR 1.50; P = 0.05). The cumulative probability of CR at 1, 2, and 5 years was 8, 13, and 27 %, respectively. There was a higher rate of clinical recurrence in patients with RS-2 compared to RS-1 on the initial postoperative endoscopy (HR 2.50; P = 0.02). In 11 patients not exposed to POMP with i-1 on initial endoscopy, only 2 patients (18 %) progressed endoscopically during the study period while 5 patients (45 %) regressed to i-0 on subsequent endoscopy without treatment.ConclusionsPostoperative medical prophylaxis decreased the likelihood of ER while certain phenotypes of CD appear to increase the risk of developing ER and CR. There may be a role for watchful waiting in patients with mild endoscopic recurrence on the initial postoperative endoscopy.

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