{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T00:16:00Z","timestamp":1793146560496,"version":"4.5.0"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2022,9,12]],"date-time":"2022-09-12T00:00:00Z","timestamp":1662940800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,3,18]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>To prevent recurrence after ileocolonic resection [ICR] in Crohn\u2019s disease [CD], postoperative prophylaxis based on risk stratification is recommended in international guidelines. This study aimed to evaluate postoperative CD recurrence after implementation of a clinical management algorithm and to determine the predictive value of clinical and histological risk factors [RFs].<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this multicentre, prospective cohort study, CD patients [\u226516 years] scheduled for ICR were included. The algorithm advised no postoperative medication for low-risk patients, and treatment with prophylaxis [immunosuppressant\/biological] for high-risk patients [\u22651 RF: active smoking, penetrating disease, prior ICR]. Clinical and histological RFs [active inflammation, granulomas, plexitis in resection margins] for endoscopic recurrence [Rutgeerts\u2019 score \u2265i2b at 6 months] were assessed using logistic regression and ROC curves based on predicted probabilities.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 213 CD patients after ICR were included [age 34.5 years; 65% women] (93 [44%] low-risk; 120 [56%] high-risk: 45 [38%] smoking; 51 [43%] penetrating disease; 51 [43%] prior ICR). Adherence to the algorithm was 82% in low-risk [no prophylaxis] and 51% in high-risk patients [prophylaxis]. Endoscopic recurrence was higher in patients treated without prophylaxis than with prophylaxis in both low [45% vs 16%, p = 0.012] and high-risk patients [49% vs 26%, p = 0.019]. Clinical risk stratification including the prescription of prophylaxis corresponded to an area under the curve [AUC] of 0.70 (95% confidence interval [CI] 0.61\u20130.79). Clinical RFs combined with histological RFs increased the AUC to 0.73 [95% CI 0.64\u20130.81].<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Adherence to this management algorithm is 65%. Prophylactic medication after ICR prevents endoscopic recurrence in low- and high-risk patients. Clinical risk stratification has an acceptable predictive value, but further refinement is needed.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ecco-jcc\/jjac128","type":"journal-article","created":{"date-parts":[[2022,9,11]],"date-time":"2022-09-11T20:14:55Z","timestamp":1662927295000},"page":"221-230","source":"Crossref","is-referenced-by-count":27,"title":["Prophylactic Medication for the Prevention of Endoscopic Recurrence in Crohn\u2019s Disease: a Prospective Study Based on Clinical Risk Stratification"],"prefix":"10.1093","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6769-4604","authenticated-orcid":false,"given":"Jeanine H C","family":"Arkenbosch","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Erasmus University Medical Center , Rotterdam , the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0819-2054","authenticated-orcid":false,"given":"Evelien M J","family":"Beelen","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Erasmus University Medical Center , Rotterdam , the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerard","family":"Dijkstra","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen , Groningen , the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mari\u00eblle","family":"Romberg-Camps","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Zuyderland Medical Center , Sittard-Geleen , the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marjolijn","family":"Duijvestein","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, AGEM Research Institute , Amsterdam , the Netherlands"},{"name":"Department of Gastroenterology and Hepatology, Radboud University Medical Center , Nijmegen , the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Hoentjen","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Radboud University Medical Center , Nijmegen , the Netherlands"},{"name":"Division of Gastroenterology, Department of Medicine, University of Alberta , Edmonton , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sander","family":"van der Marel","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Haaglanden Medical Center , The Hague , the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P W Jeroen","family":"Maljaars","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Leiden University Medical Center , Leiden , the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sita","family":"Jansen","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Reinier de Graaf Groep , Delft , the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nanne K H","family":"de Boer","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, AGEM Research Institute , Amsterdam , the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel L","family":"West","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Franciscus Gasthuis & Vlietland , Rotterdam , the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen S","family":"Horjus","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Rijnstate Hospital , Arnhem , the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurents P S","family":"Stassen","sequence":"additional","affiliation":[{"name":"Department of Surgery, Maastricht University Medical Center , Maastricht , the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fiona D M","family":"van Schaik","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, University Medical Center Utrecht , Utrecht , the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oddeke","family":"van Ruler","sequence":"additional","affiliation":[{"name":"Department of Surgery, IJsselland Hospital , Capelle aan den IJssel , the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bindia J H","family":"Jharap","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Meander Medical Center , Amersfoort , the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marijn","family":"Visschedijk","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen , Groningen , the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfred","family":"Janssen","sequence":"additional","affiliation":[{"name":"Department of Surgery, Zuyderland Medical Center , Sittard-Geleen , the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole S","family":"Erler","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Erasmus University Medical Center , Rotterdam , the Netherlands"},{"name":"Department of Epidemiology, Erasmus University Medical Center , Rotterdam , the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8611-840X","authenticated-orcid":false,"given":"Michail","family":"Doukas","sequence":"additional","affiliation":[{"name":"Department of Pathology, Erasmus University Medical Center , Rotterdam , the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariadne H A G","family":"Ooms","sequence":"additional","affiliation":[{"name":"Department of Pathology, Pathan BV , Rotterdam , the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gursah","family":"Kats-Ugurlu","sequence":"additional","affiliation":[{"name":"Department of Pathology, University Medical Center Groningen, University of Groningen , Groningen , the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christien Janneke","family":"van der Woude","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Erasmus 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