After small intestinal resection, patients with Crohn's disease who carry certain high-risk features are at substantially elevated risk of postoperative recurrence. Recognising these patients early is essential to guiding timely prophylactic therapy.
This protocol applies to patients with Crohn's disease following small intestinal resection who have at least one of the following risk factors for postoperative recurrence:
In this high-risk setting, targeted biological therapy is recommended as first-line postoperative prophylaxis. Additional pharmacological options are considered depending on the clinical context. Full agent selection, timing, and monitoring criteria are available in the complete protocol.
Prevention of postoperative endoscopic recurrence — assessed by ileocolonoscopy at 6–12 months (Rutgeerts' score below i2b).
DOI: 10.14309/ajg.0000000000003465
In patients with high-risk CD, we recommend anti-TNF therapy to prevent postoperative endoscopic recurrence (strong recommendation, moderate level of evidence).
The 3 factors that carry the greatest risk for postoperative recurrence are (i) active tobacco smoking after surgery, especially in women and heavy smokers; (ii) the presence of penetrating disease (i.e., fistulas, abscesses, and intestinal perforation); and (iii) history of 2 or more prior surgeries.
View source ↗