Advancements in the prevention and management of postoperative Crohn's disease recurrence.

Abstract

Introduction: Postoperative recurrence of Crohn's disease after surgery remains common. The aim of this article is to present a comprehensive review of recent advancements in postoperative prognostication, surveillance, and the therapeutic prophylaxis.

Areas covered: Reduction in postoperative recurrence risk is a multifactorial process requiring risk stratification, prophylactic therapeutics, and postoperative monitoring. Recent studies have explored the clinical utility of risk stratification paradigms. There are many ongoing trials including SOPRANO-CD which aims to evaluate and compare postoperative medical prophylaxis to endoscopy-driven management and POMEROL to determine optimal management strategy for moderate endoscopic disease activity. Postoperative disease activity monitoring including intestinal ultrasound, fecal calprotectin, and cross-sectional enterography offer a cost-effective and noninvasive alternative to ileocolonoscopy with new guideline recommendations for fecal calprotectin in the postoperative period. Data is emerging on outcomes between postoperative prophylactic versus endoscopy driven management algorithms. Tissue transcriptomics and serum proteomics provide a noninvasive surrogate measure of disease activity by detecting biomarkers of inflammation.

Expert opinion: Through the advancements in risk stratification, monitoring modalities and algorithms, and postoperative therapeutics, there is reduction in the rate of postoperative Crohn's recurrence.