Letter: endoscopic monitoring and treatment step‐up in post‐operative Crohn's disease

Sirs, I read with interest the “Review article: the natural history of post-operative Crohn's disease (CD) recurrence” by Buisson et al.1 The authors found that smoking was the most significant risk factor for post-operative CD recurrence. Prior intestinal resection, penetrating behaviour, perianal disease and extensive bowel disease were also risk factors for post-operative recurrence. Although these clinical parameters can be identified at the time of operation, it is not easy to make a precise assessment of risk for future recurrence in an individual patient. Furthermore, there have been few studies showing that in patients with these parameters, the risk of post-operative recurrence could be significantly reduced with medical treatment.2 The authors found that 48–93% of patients developed endoscopic lesions in the neo-terminal ileum within 1 year after surgery, whereas 20–37% had clinical recurrence.1 These results suggest that early endoscopic lesions are observed before clinical signs, and symptoms develop after surgery for CD. We conducted a prospective cohort study to investigate impacts of endoscopic findings in the neo-terminal ileum on subsequent clinical recurrence following ileocolonic resection for CD.3 There was a significant positive correlation between the endoscopic severity at 6 months after surgery and the clinical recurrence rate during the following 1 year. Thus, the severity of endoscopic inflammation in the early post-operative period should be a reliable predictive parameter for future clinical recurrence. Recently, the effects of infliximab on early endoscopic lesions after resection for CD were investigated. Two prospective studies found that infliximab therapy significantly improved endoscopic inflammation and reduced the risk of subsequent clinical recurrence.4, 5 Further studies are necessary to establish criteria for recurrence risk assessment and prophylactic treatment strategy in the management of post-operative CD. However, endoscopic monitoring and treatment step-up should be important therapeutic strategies for prevention of post-operative recurrence in patients with CD. Declaration of personal and funding interests: None.