Stenosing Crohn's Disease: Risk Factors for Endoscopic Recurrence After Surgical Resection, Concerning 31 Cases

Aims Crohn's disease is a chronic inflammatory bowel disorder that can lead to severe complications, such as intestinal stenosis, which sometimes require surgical resection. Although surgery can temporarily relieve symptoms, recurrence is common, especially in terms of endoscopic findings. Identifying risk factors for post-surgical endoscopic recurrence is crucial for optimizing the therapeutic management of patients. This study aimed to identify the risk factors for endoscopic recurrence one year after surgical resection in patients with stenosing Crohn's disease.

Methods We included 31 consecutive patients with Crohn's disease complicated by intestinal stenosis who underwent surgical resection. Among them, 26 patients received anti-TNF-α treatment post-surgery, with 22 on Adalimumab and 9 on Infliximab. Endoscopic recurrence was defined by the presence of lesions classified as i2 or higher according to the Rutgeerts classification, which is used to assess disease activity following surgical resection. We performed univariate analyses on various clinical, therapeutic, and anatomical-pathological parameters to determine factors influencing endoscopic recurrence.

Results Among the 31 patients studied, 16 (52%) experienced endoscopic recurrence within the year following surgery, while 15 patients (48%) showed no signs of recurrence. The univariate analysis revealed several factors significantly associated with endoscopic recurrence. The presence of an epithelioid giant cell granuloma in the surgical specimen was observed in 62.5% of cases in patients with recurrence, compared to 20% in those without recurrence. Additionally, a resection length equal to or greater than 30 cm was found in 66.7% of patients with recurrence, compared to 25% in those without recurrence. Regarding postoperative treatments, the use of Adalimumab was more frequently associated with endoscopic recurrence (85.7% versus 41.7%) compared to Infliximab (14.3% versus 58.3%).

Conclusions This study identifies several risk factors for endoscopic recurrence in patients with Crohn's disease after surgical resection, with over half (52%) experiencing recurrence within a year. Key risk factors include the presence of epithelioid giant cell granulomas, a resection length of 30 cm or more, and treatment with Adalimumab instead of Infliximab. The findings highlight the need for personalized postoperative follow-up and treatment to reduce recurrence risk and enhance long-term outcomes. This research enhances our understanding of endoscopic recurrence mechanisms and may inform future therapeutic strategies regarding anti-TNF-α agent selection. Further studies are required to confirm these results and explore the influence of additional factors like environment, diet, and genetics on disease recurrence.

Publication History

Article published online:
27 March 2025