@article{01HR83J2CAWWZY718F825Z1ZSE,
  abstract     = {{Background and Aims: No consensus exists on optimal strategy to prevent postoperative recurrence [POR] after ileocaecal resection [ICR] for Crohn's disease [CD]. We compared early medical prophylaxis versus expectant management with treatment driven by findings at elective endoscopy 6-12 months after ICR. Methods: A retrospective, multicentric, observational study was performed. CD patients undergoing first ICR were assigned to Cohort 1 if a biologic or immunomodulator was [re]started prophylactically after ICR, or to Cohort 2 if no postoperative prophylaxis was given and treatment was started as reaction to elective endoscopic findings. Primary endpoint was rate of endoscopic POR [Rutgeerts >i1]. Secondary endpoints were severe endoscopic POR [Rutgeerts i3/i4], clinical POR, surgical POR, and treatment burden during follow-up. Results: Of 346 included patients, 47.4% received prophylactic postoperative treatment [proactive/Cohort 1] and 52.6% did not [reactive/Cohort 2]. Endoscopic POR [Rutgeerts >i1] rate was significantly higher in Cohort 2 [41.5% vs 53.8%, OR 1.81, p = 0.039] at endoscopy 6-12 months after surgery. No significant difference in severe endoscopic POR was found [OR 1.29, p = 0.517]. Cohort 2 had significantly higher clinical POR rates [17.7% vs 35.7%, OR 3.05, p = 0.002] and numerically higher surgical recurrence rates [6.7% vs 13.2%, OR 2.59, p = 0.051]. Cox proportional hazards regression analysis showed no significant difference in time to surgical POR of proactive versus expectant/reactive approach [HR 2.50, p = 0.057]. Quasi-Poisson regression revealed a significantly lower treatment burden for immunomodulator use in Cohort 2 [mean ratio 0.53, p = 0.002], but no difference in burden of biologics or combination treatment. Conclusions: The PORCSE study showed lower rates of endoscopic POR with early postoperative medical treatment compared with expectant management after first ileocaecal resection for Crohn's disease.}},
  author       = {{Geldof, Jeroen and Truyens, Marie and Hanssens, Michiel and Van Gucht, Emily and Holvoet, Tom and Elorza, Ainara and Bouillon, Vincent and Barros, Sónia and Martins, Viviana and Argyriou, Konstantinos and Potamianos, Spyridon and Diculescu, Mircea and Stroie, Tudor and Bossuyt, Peter and Moens, Annick and Theodoraki, Eirini and Koutroubakis, Ioannis E and Pedro, Juliana and Fernandes, Samuel and Nikolaou, Pinelopi and Karmiris, Konstantinos and Baert, Filip J and Ferreiro-Iglesias, Rocio and Peeters, Harald and Claeys, Sophie and Casanova, Maria José and Eder, Piotr and Porter, Ross J and Arnott, Ian and Karakan, Tarkan and Mesonero, Francisco and Revés, Joana and Van Dyck, Evi and Jauregui-Amezaga, Aranzazu and Mañosa, Míriam and Rivière, Pauline and Marquez Mosquera, Lucia and Portela, Francisco and Pimentel, Raquel and Lobatón Ortega, Triana}},
  issn         = {{1873-9946}},
  journal      = {{JOURNAL OF CROHNS & COLITIS}},
  keywords     = {{surgery,endoscopy,postoperative recurrence [POR],ileocaecal resection,Crohn's disease}},
  language     = {{eng}},
  number       = {{8}},
  pages        = {{1202--1214}},
  title        = {{Prophylactic versus endoscopy-driven treatment of Crohn’s postoperative recurrence : a retrospective, multicentric, European study [PORCSE Study]}},
  url          = {{http://doi.org/10.1093/ecco-jcc/jjae011}},
  volume       = {{18}},
  year         = {{2024}},
}

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