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Introduction

In recent years Ileo-colic resection (ICR) has emerged as an effective treatment option for patients with ileal or ileo-caecal Crohn's disease (CD). Prophylactic treatment, including thiopurines and TNF-alpha inhibitors, have demonstrated efficacy in altering the disease course and reducing postoperative recurrence (POR). Consequently, the European Crohn’s and Colitis Organization (ECCO) published guidelines in 2016 and 2018 with consensus statements regarding postoperative care, and recommends risk-stratification for POR and prescription of prophylactic treatment to high-risk individuals. Existing data indicate suboptimal adherence to these guidelines, potentially leading to increased healthcare costs.

Aims & Methods

There is a scarcity of data on post-operative care patterns from Australia and this study aimed to evaluate guideline adherence in an Australian tertiary centre. Patients who underwent an ileocolonic resection and primary anastomosis for CD between 2017 and 2021 were retrospectively analysed. Patients with 12-month follow-up data available were included. Adherence to three specific guideline aspects: (1) prophylactic therapy prescription in high-risk patients, (2) colonoscopy within 12 months of ICR, and (3) documentation of a Rutgeerts' score at colonoscopy, were evaluated. High-risk patients were defined as those with one or more of the following risk factors for recurrence: postoperative smoking, prior CD-related intestinal resection, presence of penetrating or perianal disease, or presence of granulomas in the resection specimen.

Results

A total of 59 patients met inclusion criteria. Patient demographic data and risk factors for POR are shown in table 1. 36 (61%) underwent colonoscopy within 12 months, and 54 (92%) had a colonoscopy during the follow-up period (median 248 days, range 61 – 1764 days). A Rutgeerts' score was documented in 26/54 (48%) patients who underwent colonoscopy. Of the 50 patients with at least one risk factor for recurrence, 38 (76%) received appropriate prophylactic therapy. Risk factors for the 12 patients not appropriately prescribed prophylactic therapy included granulomata (n = 7), penetrating disease (n = 4), smoking (n = 3), prior resection (n = 2) and perianal disease (n = 1). Five of these patients had two risk factors for recurrence. In only 11 of 59 patients (19%) were all three guideline criteria satisfied.

Table 1. Patient characteristics and risk factors for recurrence
Age - median (IQR)	45 (23)
Presence of risk factors for recurrence - n (%)
Prior intestinal resection	18 (31)
Postoperative smoking	19 (17)
Presence of penetrating disease	26 (44)
Presence of granulomata in resection specimen	23 (39)
Perianal disease	9 (15)
Extensive involvement (> 50cm)	3 (5)
Any risk factor for recurrence	50 (85)

Conclusion

This study revealed suboptimal adherence to the ECCO guidelines in the studied Australian cohort, particularly in documenting Rutgeerts' score and performing colonoscopy within 12 months. It also suggests that the presence of granulomata in the resection specimen is an underrecognized risk factor for POR. The findings highlight a need for quality improvement initiatives to enhance guideline awareness and adherence among gastroenterologists.

ADHERENCE TO GUIDELINES AFTER ILEOCOLONIC RESECTION FOR CROHN'S DISEASE: AN AUSTRALIAN EXPERIENCE

Adam Haig 1, Dheeraj Shukla 2, Maneesha Bhullar 2, John Edwards 2, Naveed Ishaq 2, Laura Willmann 2, Delo Subhaharan 2, Pradeep Kakkadasam Ramaswamy 2, Waled Mohsen 2

1 Gold Coast University Hospital, Gold Coast, Australia|||Griffith University, Southport, Australia

2 Gold Coast University Hospital, Gold Coast, Australia

Conference

UEG Week Copenhagen 2023

Topics

IBD

Submission format

Abstract

Session

PP 05 IBD (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

UEG Online Course

accredited

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Perianal Crohn’s disease is a perianal complication of Crohn’s disease. It consists of inflammation near the anus in the form of skin tags, fistulas, abscesses and fissures. Affecting almost one in four Crohn’s patients, perianal Crohn’s disease needs to be assessed and treated in a multidisciplinary fashion.

This online course covers the definition and epidemiology of perianal Crohn’s disease. The diagnosis and assessment are divided into symptoms, clinical assessment and examination under anaesthesia. Various perianal Crohn’s disease treatment options are introduced, from initial medical to surgical management.

The course included comprehensive PPT slides and bespoke video presentations by Peter Irving and Amy Lightner, filmed in London and the United States in 2022. The combined material has a total duration of approximately 50 minutes. The estimated time needed to complete the course, including the final assessment, is 60 minutes.

Target audience

This course is suitable for gastroenterologists in training but is also appropriate for physicians and surgeons in other disciplines, as well as IBD clinical nurse specialists.

Perianal Crohn's disease

Peter Irving, Amy Lightner

Event

Perianal Crohn's disease

Topics

IBD Surgery

Accreditation status

accredited

Duration

1 hour

Published

2023

UEG Standards and Guidelines

Clinical Practice Guideline

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Abstract

This article is the second in a series of two publications on the European Crohn’s and Colitis Organisation [ECCO] evidence-based consensus on the management of Crohn’s disease. The first article covers medical management; the present article addresses surgical management, including preoperative aspects and drug management before surgery. It also provides technical advice for a variety of common clinical situations. Both articles together represent the evidence-based recommendations of the ECCO for Crohn’s disease and an update of prior ECCO Guidelines.

ECCO Guidelines on Therapeutics in Crohn's Disease: Surgical Treatment

Michel Adamina

Publisher

European Crohn’s and Colitis Organisation

Guideline

Clinical Practice Guideline

Topics

IBD Surgery

Citation

Journal of Crohn's and Colitis, Volume 18, Issue 10, October 2024, Pages 1556–1582

Published

2024

UEG Presentation

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… after ileocecal resection of localised Crohn's disease

Matthieu Allez 1

1 Saint-Louis Hospital, AP-HP, Université Paris Cité, Paris, France

Event

UEG Week Berlin 2025

Topics

Colorectal IBD Surgery

Session

Predicting patient outcomes...

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Standards and Guidelines

Clinical Practice Guideline

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Introduction

Crohn’s disease [CD] is a chronic inflammatory bowel disease [IBD] that can result in progressive bowel damage and disability. CD can affect individuals of any age, from children to the elderly,^2,3 and may cause significant morbidity and impact on quality of life [QoL]. The precise aetiology of CD remains unknown and a curative therapy is not yet available. Contemporary therapy therefore is focused on control of inflammation, using medications along with timely surgical interventions to alleviate the symptoms of bowel damage.

ECCO Guidelines on Therapeutics in Crohn's Disease: Medical Treatment

Hannah Gordon

Publisher

European Crohn’s and Colitis Organisation

Guideline

Clinical Practice Guideline

Topics

IBD

Citation

Journal of Crohn's and Colitis, Volume 18, Issue 10, October 2024, Pages 1531–1555

Published

2024

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Introduction

Recent studies have demonstrated the efficacy of ileocolonic resection in the treatment of ileal Crohn’s disease (CD). Stratification based on risk of recurrence is current standard of care, with international guidelines recommending prophylaxis to high-risk patients. Existing data indicate suboptimal adherence to these guidelines, potentially leading to increased healthcare costs. This study aimed to evaluate (1) guideline adherence in the postoperative setting, and (2) the impact of guideline driven prophylaxis on post-operative endoscopic recurrence (POR).

Aims & Methods

We performed a retrospective cohort study of patients who underwent ileal or ileocolonic resection and anastomosis for CD between 2017 and 2021 in four Australian centres. Adherence to three specific guideline aspects was assessed: (1) colonoscopy within 12 months, (2) documentation of a Rutgeert’s score at colonoscopy, and (3) prophylactic therapy prescription in high-risk patients. High-risk patients were defined as those with one or more of the following risk factors for recurrence: postoperative smoking, prior CD-related intestinal resection, presence of penetrating or perianal disease, or presence of granulomas in the resection specimen. Early POR (defined as a Rutgeert’s score of ≥ i2 within 12 months of surgery) was assessed; if this was not documented, it was inferred from the report text and available images.

Results

A total of 180 patients were analysed, with a median age of 46 years, and of whom 55% were female. Disease was confined to the ileum in 59% of patients, and 18% had additional perianal involvement. Disease behaviour was stricturing in 66% and penetrating in 30%. 32% of the cohort had undergone prior ileocolonic resection, and 25% were smokers.122 (68%) underwent colonoscopy within 12 months, and 162 (90%) had a colonoscopy during the follow-up period (median 240 days, IQR: 174 – 402 days). A Rutgeert’s score was documented in 89/162 (55%). Of the 142 (79%) patients with at least one risk factor for recurrence, 98 (69%) received prophylactic therapy. Early POR occurred in 54 of 122 patients (44%) who underwent timely colonoscopy (high-risk group 43/94, 46%; low-risk group 11/28, 39%, p = 0.55). Prophylactic therapy in the high-risk group did not reduce early POR (28/62, 45% vs 15/32, 47%, p = 0.87).

Table 1. Selected Results n (%)
Colonoscopy within 6-12 months	122 (68)
Rutgeert’s score documentation	89 (55)
Prophylaxis in high-risk group	98 (69)
Prophylaxis in low-risk group	20 (53)
Early post-operative recurrence (POR)
High-risk group (all)	43 (46)*
High-risk group, prophylaxis prescribed	28 (45)
Low-risk group	11 (39)*
* no difference in POR between high-risk and low-risk groups (p = 0.55)

Conclusion

Adherence to guidelines in the management of postoperative Crohn’s is suboptimal, particularly in the documentation of a Rutgeert’s score. Irrespective of prophylactic therapy prescription in our cohort, early POR remains high, and guideline driven prophylaxis did not significantly reduce this rate. Additionally, recurrence was still high in patients without traditional risk factors for recurrence. This invites further investigation into alternative risk-stratification and treatment strategies to reduce POR in Crohn’s disease.