Time Trends in Strategies for Postoperative Crohn's Disease Management and Long-Term Surgical Recurrence: ENEIDA...

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 past 3 decades.

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).

A total of 4890 patients were included (23% BB, 38% EB, and 39% WB). A significant increase in medical prevention of POR with both thiopurines (BB, 12%; EB, 47%; and WB, 37%; P < .001) and biological agents (BB, 0%; EB, 9%; and WB, 37%; P < .001) was observed. Medical treatment with biologicals for POR also increased (BB, 35%; EB, 48%; and WB, 43%; P < .001). The cumulative surgical POR-free survival rate at 5 and 10 years was significantly higher in both the EB and WB cohorts as compared with the BB cohort (BB, 92% and 83%; EB, 96% and 90%; WB, 97% and 91%, respectively; P < .001).

Medical prevention for POR after the first intestinal resection for CD increased significantly in the past 2 decades, alongside the use of biologicals to treat POR. These changes were associated with a significant decrease in the cumulative probability of surgical POR.