Indications, postoperative management, and long-term prognosis of Crohn's disease after ileocecal resection: A Multicenter Study Comparing the East and West

Jeanine H C Arkenbosch, Joyce W Y Mak, Jacky C L Ho, Evelien M J Beelen, Nicole S Erler, Frank Hoentjen, Alexander G L Bodelier, Gerard Dijkstra, Mariëlle Romberg-Camps, Nanne K H de Boer, Laurents P S Stassen, Andrea E van der Meulen, Rachel West, O van Ruler, C Janneke van der Woude, Siew C Ng, Annemarie C de Vries*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND: Crohn's disease (CD) phenotype differs between Asian and Western countries and may affect disease management, including decisions on surgery. This study aimed to compare the indications, postoperative management, and long-term prognosis after ileocecal resection (ICR) in Hong Kong (HK) and The Netherlands (NL).

METHODS: CD patients with primary ICR between 2000 and 2019 were included. The endpoints were endoscopic (Rutgeerts' score ≥i2b and/or radiologic recurrence), clinical (start or switch of IBD medication) and surgical recurrences. Cumulative incidences of recurrence were estimated with a Bayesian multivariable proportional hazards model.

RESULTS: Eighty HK and 822 NL patients were included. The most common indication for ICR was penetrating disease (HK 32.5%, NL 22.5%) in HK versus stricturing disease (HK 32.5%, NL 48.8%) in NL (P<0.001). Postoperative prophylaxis was prescribed to 65 (81.3%) HK (28 [35.0%] amino salicylates [5-ASA]; 30 [37.5%] immunomodulators [IM]; 0 biologicals) versus 388 (47.1%) NL patients (67 [8.2%] 5-ASA; 187 [22.8%] IM; 69 [8.4%] biologicals; 50 [6.1%] combination therapy, P<0.001). Endoscopic or radiologic evaluation within 18 months was performed in 36.3% HK versus 64.1% NL (P< 0.001) patients. No differences between both populations were observed for endoscopic (hazard ratio [HR]: 0.53 (95% confidence interval [CI]: 0.24-1.21), clinical (HR: 0.91 (95% CI: 0.62-1.32), or surgical (HR: 0.61 (95% CI: 0.31-1.13)) recurrence risks.

CONCLUSION: The main indication for ICR in CD patients is penetrating disease in HK patients and stricturing disease in NL patients. Although considerable pre- and post-operative management differences were observed between the two geographical areas, the long-term prognosis after ICR is similar.

Original languageEnglish
Pages (from-to)S16-S24
Number of pages9
JournalInflammatory Bowel Diseases
Volume28
Issue numberSUPPL 2
Early online date30 Dec 2021
DOIs
Publication statusPublished - 2 Jun 2022

Keywords

  • ASIA-PACIFIC CROHNS
  • COHORT
  • Crohn's disease
  • INFLAMMATORY-BOWEL-DISEASE
  • INTRAABDOMINAL SEPTIC COMPLICATIONS
  • METAANALYSIS
  • OPTIMIZATION
  • PHENOTYPE
  • PREVALENCE
  • SURGERY
  • TIME
  • ileocecal resection
  • postoperative recurrence

Cite this