J Crohns Colitis. 2025 Nov 9:jjaf190. doi: 10.1093/ecco-jcc/jjaf190. Online ahead of print.
ABSTRACT
INTRODUCTION: While ileocolic resection is the most common surgical procedure for Crohn’s disease (CD), many physicians prefer to initiate pharmacotherapy before considering surgery. This study aimed to compare early ileocolic resection (EICR) with medical treatment (MT) for localized ileocolic CD.
METHODS: A systematic search was conducted across PubMed, Cochrane, Embase, and Google Scholar. Inclusion criteria required studies to compare EICR (performed within 18 months of initial diagnosis) without the use of biologics to MT, with primary outcomes being the need for CD-related surgery and the use of biologics.
RESULTS: Five studies involving 1,770 patients, both pediatric and adult, were included in this analysis. The data showed that in the EICR cohort, which comprised 740 patients, the rate of Crohn’s disease-related surgery within five years of initial treatment was 2.43%. In contrast, the MT cohort, consisting of 1,030 patients, had a much higher surgery rate of 20.58% (p < 0.001). Additionally, at a mean follow-up of five years, the long-term use of biologics was significantly lower in the EICR cohort compared to the MT cohort, with rates of 18.38% and 72.91% respectively (p < 0.001).
CONCLUSION: An EICR operation for localized ileocolic CD was associated with longer and more stable remission, resulting in improved long-term outcomes compared to medical therapy alone. In cases of localized ileocolic CD where medical treatment fails to improve disease activity after several months, early surgical intervention may provide a safe and effective way to achieve disease remission and enhance the overall quality of life for patients.
PMID:41206924 | DOI:10.1093/ecco-jcc/jjaf190
