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 language | English |
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Pages (from-to) | S16-S24 |
Number of pages | 9 |
Journal | Inflammatory Bowel Diseases |
Volume | 28 |
Issue number | SUPPL 2 |
Early online date | 30 Dec 2021 |
DOIs | |
Publication status | Published - 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