- Hernández-Rocha, Cristian;
- Walshe, Margaret;
- Birch, Sondra;
- Sabic, Ksenija;
- Korie, Ujunwa;
- Chasteau, Colleen;
- Miladinova, Vessela;
- Sabol, William;
- Mengesha, Emebet;
- Hanna, Mary;
- Pozdnyakova, Valeriya;
- Datta, Lisa;
- Kohen, Rita;
- Milgrom, Raquel;
- Stempak, Joanne;
- Bitton, Alain;
- Brant, Steven;
- Rioux, John;
- McGovern, Dermot;
- Duerr, Richard;
- Cho, Judy;
- Schumm, Phil;
- Silverberg, Mark;
- Lazarev, Mark
BACKGROUND AND AIMS: Multiple factors are suggested to place Crohns disease patients at risk of recurrence after ileocolic resection with conflicting associations. We aimed to identify clinical predictors of recurrence at first [early] and further [late] postoperative colonoscopy. METHODS: Crohns disease patients undergoing ileocolic resection were prospectively recruited at six North American centres. Clinical data were collected and endoscopic recurrence was defined as Rutgeerts score ≥i2. A multivariable model was fitted to analyse variables independently associated with recurrence. RESULTS: A total of 365 patients undergoing 674 postoperative colonoscopies were included with a median age of 32 years, 189 [51.8%] were male, and 37 [10.1%] were non-Whites. Postoperatively, 133 [36.4%] used anti-tumour necrosis factor [anti-TNF] and 30 [8.2%] were smokers. At first colonoscopy, 109 [29.9%] had recurrence. Male gender (odds ratio [OR] = 1.95, 95% confidence interval [CI] 1.12-3.40), non-White ethnicity [OR = 2.48, 95% CI 1.09-5.63], longer interval between surgery and colonoscopy [OR = 1.09, 95% CI 1.002-1.18], and postoperative smoking [OR = 2.78, 95% CI 1.16-6.67] were associated with recurrence, while prophylactic anti-TNF reduced the risk [OR = 0.28, 95% CI 0.14-0.55]. Postoperative anti-TNF prophylaxis had a protective effect on anti-TNF experienced patients but not on anti-TNF naïve patients. Among patients without recurrence at first colonoscopy, Rutgeerts score i1 was associated with subsequent recurrence [OR = 4.43, 95% CI 1.73-11.35]. CONCLUSIONS: We identified independent clinical predictors of early and late Crohns disease postoperative endoscopic recurrence. Clinical factors traditionally used for risk stratification failed to predict recurrence and need to be revised.