ECCO-EFCCA Patient Guidelines on Crohn’s Disease (CD)

is the most sensitive tool to document disease recurrence. Relapse can be detected using
colonoscopy and biopsy within a few weeks to months after surgery and should be
performed within one year after surgery. Relapse is usually apparent in colonoscopy
before the patient gets symptoms. If the findings during colonoscopy are severe, the
treatment should be intensified to prevent the development of early post-operative
complications, such as abscesses or obstructions.
There are new, less invasive diagnostic methods that help in identifying the return of the
disease after surgery. These methods include faecal calprotectin, abdominal ultrasound,
MR enterography with contrast agent, and small bowel capsule endoscopy (SBCE).
Radiology and imaging (US, MR, and CT) are being evaluated as independent diagnostic
methods for postoperative recurrence. Small bowel capsule endoscopy performed 6 or 12
months after surgery appears to be about as accurate as ileocolonoscopy in diagnosing
post-operative recurrence. However, it has not been studied whether MRI, CT
enterography, or small bowel capsule endoscopy are able to diagnose relapse in the
ileum or jejunum.
Prevention of subsequent surgery following ileocolonic resection
For patients who have at least one risk factor for recurrence of the disease, preventive
treatment is recommended after ileocolonic resection (i.e. removal of the end of the
small bowel and first part of the colon). The best preventive treatment is thiopurines or
anti-TNF. Mesalazine in high doses is an option for patients who have only had the end of
the small bowel removed. Antibiotics are effective after ileocolonic resection, but they are
not as well tolerated.
All patients with CD should be informed of the risk associated with smoking. Smoking
cessation should be encouraged and supported.
Smoking is one of the biggest risk factors for relapse and increased need for surgical
resection in Crohn’s Disease. Therefore, all Crohn’s Disease patients should do their
absolute best to quit smoking.
Management of Fistulizing CD
Diagnostic Strategies
Pelvic MRI is the first method for the assessment of perianal fistulae in CD. If rectal
stricture (i.e. narrowing) is ruled out, endoscopic ultrasound of the rectum is a good
option. Both methods are more precise when combined with examination under
anaesthetic (EUA). Fistulography is not recommended. If a fistula in the anal area is
found, EUA done by an experienced surgeon is the best method.
MRI, if possible, should be initially used because it has an accuracy of 76-100%.
Nevertheless, if an MRI is not available promptly, an examination under anaesthetic with
drainage of the abscess or fistula should be done as soon as possible to avoid the
dangers of an undrained infection; examination under anaesthetic is 90% accurate and
allows the surgeon to drain the abscess at the time of the examination.
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