Impact of treatment adjustment on the endoscopic prognosis of postoperative anastomotic lesions in patients with Crohn's disease.

Background: Anastomotic ulcers are common after ileocolonic resection in patients with Crohn's disease (CD). However, the endoscopic prognosis of isolated anastomotic lesions after treatment adjustment remains unclear.

Methods: We retrospectively included CD patients with anastomotic lesions who were referred to our center for ileocolonoscopy between 2020 and 2024. We conducted an initial evaluation of the impact of treatment adjustment on the endoscopic prognosis of anastomotic lesions. Additionally, we analyzed the association between different adjustment strategies and endoscopic outcome.

Results: In total, 199 eligible CD patients with anastomotic lesions were included in our study. Treatment adjustment promoted mucosal healing (multivariable Cox HR: 2.376, 1.400-4.032, p=0.001) and endoscopic improvement (multivariable Cox HR: 2.373, 1.596-3.530, p<0.001). We also found that the endoscopic ulcer improvement of biologics to biologics switching was superior to that of non-treatment adjustment (Cox HR: 2.055, 1.212-3.482, p=0.007). Cox regression analyses further confirmed that non-biologics to biologics switching was associated with better endoscopic mucosal healing(Cox HR: 2.751, 1.494-5.063, p=0.001) and ulcer improvement(Cox HR: 2.154, 1.322-3.509, p=0.002). Regarding patients with insufficient trough levels of biologics, biologic optimization significantly improved endoscopic mucosal healing (Cox HR: 2.854, 1.345-6.053, p=0.006) and endoscopic ulcer improvement (Cox HR: 2.344, 1.288-4.265, p=0.005).

Conclusions: Treatment adjustment contributed to the improvement of endoscopic prognosis in anastomotic lesions patients. Different adjustment strategies (biologics to biologics switching, non-biologics to biologics switching, biologic optimization) similarly resulted in better endoscopic outcome.