Endoscopic Recurrence in Crohn's Disease Patients With Long-Term Ileostomy

A small but significant proportion of patients with Crohn's disease (CD) will ultimately require a permanent ileostomy. So far, research has focused primarily on clinical and surgical recurrence rates in the ileum, leaving endoscopic recurrence largely unexplored. The aim of this study was to explore the endoscopic ileal recurrence rate in patients with a long-term ileostomy and to identify potential risk factors.

We performed a retrospective study of adult CD patients with a long-term ileostomy (≥12 months) at a tertiary referral center.

Through an electronic health record database search, we were able to identify 150 patients. One hundred sixteen patients (77.3%) underwent at least one endoscopic examination of the ileum. Ileal recurrence was detected in 46/116 (39.7%). The 1, 3, and 5-year endoscopic recurrence rates were 11.2%, 27.3%, and 33.0%, respectively. Patients with earlier ileal involvement (hazard ratio [HR] 1.99, 95% confidence interval [CI] 1.09-3.62; P = .02) or previous biological therapy (HR 2.48, 95% CI 1.25-4.89; P = .01) were at higher risk. Fecal calprotectin in ileostomy effluent accurately predicted endoscopic inflammation at a cutoff of 170 mcg/g (sensitivity 77.8%, specificity 94.7%, accuracy 89.9%).

In this retrospective study, 77.3% of ileostomy patients underwent endoscopic assessment during follow-up. Ileal recurrence was detected in 39.7% of patients who underwent endoscopic evaluation. Patients with ileal involvement or preoperative exposure to biologics had the highest risk of recurrence. These patients might benefit from endoscopic monitoring. Fecal calprotectin is a reliable noninvasive marker for detecting ileal inflammation.