Principal changes with respect to the 2004 ECCO guidelines 

Ileocolonoscopy is recommended within the first year after surgery where treatment decisions may be affected (Statement 8C).

Thiopurines are more effective than mesalazine or imidazole antibiotics alone in post-operative prophylaxis (Statement 8F).

### 8.1 Epidemiology of post-operative Crohn's disease

In the natural history of CD, intestinal resection is almost unavoidable since about 80% of patients require surgery at some stage. Surgery is unfortunately not curative as the disease inexorably recurs in many patients. The post-operative recurrence rate varies according to the definition used: clinical, endoscopic, radiological, or surgical. It is lowest when the repeat resection rate is considered, intermediate when clinical indices are used and highest when endoscopy is employed as the diagnostic tool.1–10

Data from endoscopic follow-up of patients after resection of ileo-caecal disease have shown that in the absence of treatment, the post-operative recurrence rate is around 65–90% within 12 months and 80–100% within 3 years of the operation. The clinical recurrence without therapy is about 20–25%/year.1,10 It has been demonstrated that the post-operative clinical course of CD is best predicted by the severity of endoscopic lesions. Symptoms, in fact, appear only when severe lesions are present and it is not uncommon to observe patients with fairly advanced recurrent lesions at endoscopy who remain asymptomatic.1 For these reasons, clinical indices such as the CDAI have low sensitivity at discriminating between patients with or without post-operative recurrence.11

These data mandate strategies aimed at interrupting or delaying the natural course of post-operative recurrence. Several medications have been tried in an attempt to prevent post-operative recurrence, mostly with disappointing results. The aim of this Consensus was therefore critically to evaluate the optimal strategies for the management of post-operative recurrence in CD. Most, if not all, of the evidence available deals with …

/pdf/the-second-european-evidence-based-consensus-on-the-430j75rc37.pdf

The second European evidence-based Consensus on the diagnosis and management of Crohn's disease: Special situations

AGA technical review on perianal Crohn's disease.

https://www.gastrojournal.org/article/S0016-5085(01)36224-8/pdf

A comparison of endoscopic ultrasound, magnetic resonance imaging, and exam under anesthesia for evaluation of Crohn's perianal fistulas

This third section of the European Crohn's and Colitis Organisation (ECCO) Consensus on the management of Crohn's disease concerns postoperative recurrence, fistulating disease, paediatrics, pregnancy, psychosomatics, extraintestinal manifestations, and alternative therapy. The first section on definitions and diagnosis reports on the aims and methods of the consensus, as well as sections on diagnosis, pathology, and classification of Crohn's disease. The second section on current management addresses treatment of active disease, maintenance of medically induced remission, and surgery of Crohn's disease.

https://gut.bmj.com/content/gutjnl/55/suppl_1/i36.full.pdf

European evidence based consensus on the diagnosis and management of Crohn's disease: special situations.

https://www.gastrojournal.org/article/S0016-5085(07)01642-3/pdf

Diagnostics of Inflammatory Bowel Disease

To investigate the potential of MR imaging in the evaluation of sinus tracts or fistulae associated with Crohn disease, 17 patients with pelvic or abdominal fistulae or sinus tracts underwent MR imaging with multislice spin-echo techniques, 500/15 and 1600/22,80 (TR/TE). The presence of fistulae and/or sinus tracts was confirmed by contrast-enhanced CT (n = 17) and/or sonography (n = 8), sinography (n = 6), or barium studies (n = 4). In all but three cases the fistulae and extramucosal inflammatory abnormalities were shown by MR. T1-weighted images provided excellent delineation of the extension of the fistulae relative to sphincters and adjacent hollow viscera and showed inflammatory changes in fat planes. T2-weighted images showed fluid collections within the fistulae, localized fluid collections in extraintestinal tissues, and inflammatory changes within muscles. The supralevator and infralevator compartments were well defined on coronal images. Thus, the perirectal spread of fistulae and sinus tracts ...

https://www.ajronline.org/doi/pdfplus/10.2214/ajr.152.5.999

P Weber

Papers

Diagnosis of fistulae and sinus tracts in patients with Crohn disease: value of MR imaging