Time trends in strategies for postoperative Crohn's disease management and long-term surgical recurrence: ENEIDA registry data.

Autores de IIS La Fe

• Guillermo Bastida Paz

  Autor

Participantes ajenos a IIS La Fe

• Piñero G
• Mañosa M
• Ricart E
• Calafat M
• De Francisco R
• Mesonero F
• Iglesias-Flores E
• Bosca-Watts MM
• Vera I
• de Castro L
• Martín-Arranz MD
• Alba C
• Rivero M
• Guardiola J
• Arranz-Hernández L
• Arias-García L
• Varela P
• Giordano A
• Gisbert JP
• Barrio J
• Brunet-Mas E
• Belén-Galipienso O
• García-López S
• Domènech E
• ENEIDA registry of the GETECCU

Grupos

• Enfermedad Inflamatoria Intestinal

Abstract

BACKGROUND: The availability of biologicals has been associated with a decreased rate of first intestinal resection in patients with Crohn's disease (CD). However, its impact on postoperative recurrence (POR) has received little attention. We aimed to assess time trends in the strategies for the management of postoperative CD and the rate of second surgeries over the last three decades. METHODS: Adult patients with CD who had undergone a first ileocolic resection between 1990 and 2020 were identified from the Spanish ENEIDA registry. Patients were grouped by date of surgery as follows: before the biological era ([BB] 1990-2000), in the early biological era ([EB] 2000-2010), and in the widespread biological era ([WB] 2011-2020). RESULTS: A total of 4,890 patients were included (23% BB, 38% EB, 39% WB). A significant increase in medical prevention of POR with both thiopurines (BB 12%, EB 47%, WB 37%; P<0.001) and biological agents (BB 0%, EB 9%, WB 37%; P<0.001) was observed. Medical treatment with biologicals for POR also increased (BB 35%, EB 48%, WB 43%; P<0.001). The cumulative surgical POR-free survival rate at five and ten years was significantly higher in both EB and WB cohorts as compared to BB (BB 92%, 83%; EB 96%, 90%; WB 97%and 91%, respectively; P<0.001). CONCLUSIONS: Medical prevention for POR after the first intestinal resection for CD increased significantly in the last two decades, alongside the use of biologicals to treat POR. These changes were associated with a significant decrease in the cumulative probability of surgical POR.

Copyright © 2026 American Gastroenterological Association Institute. Published by Elsevier Inc. All rights reserved.

Keywords

• Crohn`s disease; postoperative recurrence; postoperative strategies; second surgery