Clinical, Radiological, and Surgical Risk Factors for Endoscopic Anastomotic Recurrence Following Surgery in Crohn's Disease

This study investigated the radiological, clinical, and surgical factors linked to the risk of endoscopic recurrence following ileocolic resection for Crohn's disease. We conducted a retrospective analysis of data from all patients who underwent primary ileocecal resection for Crohn's disease in a single colorectal unit between 2004 and 2020. We analyzed the potential risk factors subdivided by the clinical, radiological, and surgical factors associated with morphological recurrence, as detected by endoscopy within 2 years after surgery. Cox regression was employed to ascertain the risk factors associated with such recurrence. In total, 63 patients were included, and 24 (38%) had endoscopic recurrence. The age of the patient at the time of surgery was identified as a significant clinical factor associated with the risk of recurrence (HR: 1.04; = 0.003), indicating that the probability of recurrence increases by 1% as the surgical age increases each year. The radiological factors associated with an increased risk of recurrence included localization in the distal ileum (HR: 3.526; = 0.015), the number of pathological small-bowel segments affected by the disease (HR: 1.15; = 0.004), and the total length of the pathological intestinal segment (HR: 1.002; = 0.014). The presence of granulomas (HR: 6.003; = 0.004) and the length of the resected bowel (HR: 1.01; = 0.003) were surgical factors associated with a higher risk of recurrence. This study delineated several clinical, radiological, and surgical factors that serve as predictors for the endoscopic recurrence of Crohn's disease after surgery.