Suboptimal Guideline Adherence and Biomarker Underutilization in Monitoring of Post-operative Crohn’s Disease
Research output: Contribution to journal › Journal article › Research › peer-review
Standard
Suboptimal Guideline Adherence and Biomarker Underutilization in Monitoring of Post-operative Crohn’s Disease. / Li, Terry; Click, Benjamin; Bachour, Salam; Sachs, Michael; Barnes, Edward L.; Cohen, Benjamin L.; Contreras, Susell; Axelrad, Jordan.
In: Digestive Diseases and Sciences, Vol. 68, 2023, p. 3596–3604.Research output: Contribution to journal › Journal article › Research › peer-review
Harvard
APA
Vancouver
Author
Bibtex
}
RIS
TY - JOUR
T1 - Suboptimal Guideline Adherence and Biomarker Underutilization in Monitoring of Post-operative Crohn’s Disease
AU - Li, Terry
AU - Click, Benjamin
AU - Bachour, Salam
AU - Sachs, Michael
AU - Barnes, Edward L.
AU - Cohen, Benjamin L.
AU - Contreras, Susell
AU - Axelrad, Jordan
N1 - Publisher Copyright: © 2023, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
PY - 2023
Y1 - 2023
N2 - Background: Crohn’s disease recurrence after ileocecal resection is common. Guidelines suggest colonoscopy within 6–12 months of surgery to assess for post-operative recurrence, but use of adjunctive monitoring is not protocolized. We aimed to describe the state of monitoring in post-operative Crohn’s. Methods: We conducted a retrospective study of patients with Crohn’s after ileocolic resection with ≥ 1-year follow-up. Patients were stratified into high and low risk based on guidelines. Post-operative biomarker (C-reactive protein, fecal calprotectin), cross-sectional imaging, and colonoscopy use were assessed. Biomarker, radiographic, and endoscopic post-operative recurrence were defined as elevated CRP/calprotectin, active inflammation on imaging, and Rutgeerts ≥ i2b, respectively. Data were stratified by surgery year to assess changes in practice patterns over time. P-values were calculated using Wilcoxon test and Fisher exact test. Results: Of 901 patients, 53% were female and 78% high risk. Median follow-up time was 60 m for LR and 50 m for high risk. Postoperatively, 18% low and 38% high risk had CRPs, 5% low and 10% high risk had calprotectins, and half of low and high risk had cross-sectional imaging. 29% low and 38% high risk had colonoscopy by 1 year. Compared to pre-2015, time to first radiography (584 days vs. 398 days) and colonoscopy (421 days vs. 296 days) were significantly shorter for high-risk post-2015 (P < 0.001). Probability of colonoscopy within 1 year increased over time (0.48, 2011 vs. 0.92, 2019). Conclusion: Post-operative colonoscopy completion by 1 year is low. The use of CRP and imaging are common, whereas calprotectin is infrequently utilized. Practice patterns are shifting toward earlier monitoring.
AB - Background: Crohn’s disease recurrence after ileocecal resection is common. Guidelines suggest colonoscopy within 6–12 months of surgery to assess for post-operative recurrence, but use of adjunctive monitoring is not protocolized. We aimed to describe the state of monitoring in post-operative Crohn’s. Methods: We conducted a retrospective study of patients with Crohn’s after ileocolic resection with ≥ 1-year follow-up. Patients were stratified into high and low risk based on guidelines. Post-operative biomarker (C-reactive protein, fecal calprotectin), cross-sectional imaging, and colonoscopy use were assessed. Biomarker, radiographic, and endoscopic post-operative recurrence were defined as elevated CRP/calprotectin, active inflammation on imaging, and Rutgeerts ≥ i2b, respectively. Data were stratified by surgery year to assess changes in practice patterns over time. P-values were calculated using Wilcoxon test and Fisher exact test. Results: Of 901 patients, 53% were female and 78% high risk. Median follow-up time was 60 m for LR and 50 m for high risk. Postoperatively, 18% low and 38% high risk had CRPs, 5% low and 10% high risk had calprotectins, and half of low and high risk had cross-sectional imaging. 29% low and 38% high risk had colonoscopy by 1 year. Compared to pre-2015, time to first radiography (584 days vs. 398 days) and colonoscopy (421 days vs. 296 days) were significantly shorter for high-risk post-2015 (P < 0.001). Probability of colonoscopy within 1 year increased over time (0.48, 2011 vs. 0.92, 2019). Conclusion: Post-operative colonoscopy completion by 1 year is low. The use of CRP and imaging are common, whereas calprotectin is infrequently utilized. Practice patterns are shifting toward earlier monitoring.
KW - Biomarkers
KW - C-reactive protein
KW - Calprotectin
KW - Crohn’s disease
KW - Inflammatory bowel disease
KW - Post-operative recurrence
U2 - 10.1007/s10620-023-08044-7
DO - 10.1007/s10620-023-08044-7
M3 - Journal article
C2 - 37548896
AN - SCOPUS:85166938167
VL - 68
SP - 3596
EP - 3604
JO - Digestive Diseases and Sciences
JF - Digestive Diseases and Sciences
SN - 0163-2116
ER -
ID: 362681191