- Fecal Incontinence
|Postoperative Crohn's Disease Management
Curr Opin Gastroenterol. 2020 Apr 16. doi: 10.1097/MOG.0000000000000638.Online ahead of print.
Edward L Barnes 1 2 3
1Division of Gastroenterology and Hepatology, Department of Medicine.
2Multidisciplinary Center for Inflammatory Bowel Diseases.
3Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Purpose of review: Despite multiple advances in the medical treatment of Crohn's disease, it is recognized that a significant proportion of patients will ultimately require surgical resection at some point during their disease course. This review focuses on the postoperative management of patients with Crohn's disease, with the goal of preventing endoscopic and clinical recurrence, and future surgery.
Recent findings: Surgery is an integral part of the multidisciplinary approach to the management of patients with Crohn's disease. Recent literature and guidelines have focused on a standardized and evidence-based approach to the management of patients in the postoperative setting. This approach should utilize risk stratification at the time of surgery, initiation of appropriate therapy among high-risk patients, and objective evaluation in the postoperative period, including ileocolonoscopy at 6-12 months after a surgical resection.
Summary: A standardized approach to the postoperative management of patients with Crohn's disease is critical. Identifying those patients at high-risk for endoscopic and clinical recurrence is essential, as these patients will likely require early medical therapy. While novel objective assessments are emerging, all patients should undergo ileocolonoscopy at 6-12 months and further decision making should be based on the presence of endoscopic recurrence.