Suboptimal Guideline Adherence and Biomarker Underutilization in Monitoring of Post-operative Crohn’s Disease

Terry Li, Benjamin Click, Salam Bachour, Michael Sachs, Edward L. Barnes, Benjamin L. Cohen, Susell Contreras, Jordan Axelrad

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background: Crohn’s disease recurrence after ileocecal resection is common. Guidelines suggest colonoscopy within 6–12 months of surgery to assess for post-operative recurrence, but use of adjunctive monitoring is not protocolized. We aimed to describe the state of monitoring in post-operative Crohn’s. Methods: We conducted a retrospective study of patients with Crohn’s after ileocolic resection with ≥ 1-year follow-up. Patients were stratified into high and low risk based on guidelines. Post-operative biomarker (C-reactive protein, fecal calprotectin), cross-sectional imaging, and colonoscopy use were assessed. Biomarker, radiographic, and endoscopic post-operative recurrence were defined as elevated CRP/calprotectin, active inflammation on imaging, and Rutgeerts ≥ i2b, respectively. Data were stratified by surgery year to assess changes in practice patterns over time. P-values were calculated using Wilcoxon test and Fisher exact test. Results: Of 901 patients, 53% were female and 78% high risk. Median follow-up time was 60 m for LR and 50 m for high risk. Postoperatively, 18% low and 38% high risk had CRPs, 5% low and 10% high risk had calprotectins, and half of low and high risk had cross-sectional imaging. 29% low and 38% high risk had colonoscopy by 1 year. Compared to pre-2015, time to first radiography (584 days vs. 398 days) and colonoscopy (421 days vs. 296 days) were significantly shorter for high-risk post-2015 (P < 0.001). Probability of colonoscopy within 1 year increased over time (0.48, 2011 vs. 0.92, 2019). Conclusion: Post-operative colonoscopy completion by 1 year is low. The use of CRP and imaging are common, whereas calprotectin is infrequently utilized. Practice patterns are shifting toward earlier monitoring.

Original languageEnglish
Pages (from-to)3596-3604
Number of pages9
JournalDigestive Diseases and Sciences
Volume68
Issue number9
DOIs
StatePublished - Sep 2023
Externally publishedYes

Keywords

  • Biomarkers
  • C-reactive protein
  • Calprotectin
  • Crohn’s disease
  • Inflammatory bowel disease
  • Post-operative recurrence

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