Original ResearchFull Report: Clinical—Alimentary TractMeasurement of Fecal Calprotectin Improves Monitoring and Detection of Recurrence of Crohn's Disease After Surgery
Section snippets
The Clinical Postoperative Recurrence Study
The POCER study was a prospective, randomized, controlled trial that aimed to assess the value of postoperative endoscopic assessment and treatment step-up for early mucosal recurrence.10 Patients were stratified according to risk of recurrence. Smokers, patients with perforating disease, or patients with 1 or more previous resections were classified as high risk; all others were classified as low risk. All patients underwent resection of all macroscopic disease.
Patients may have had previous
Results
Supplementary Figure 1 shows the study patient disposition. Demographic details of patients who provided stool samples are shown in Table 1.
Baseline patient demographics were similar for the 3 analysis groups. The number of patients and samples that contributed to each analysis and the rates of endoscopic recurrence are detailed in Table 2.
Discussion
The majority of patients with Crohn’s disease require a resection at some time, and most of these patients will require further surgery. The POCER study recently showed that postoperative endoscopic monitoring, together with treatment intensification for early recurrence, is superior to standard drug therapy alone in preventing disease recurrence, at least in the short term.10 However, such endoscopic monitoring is invasive, expensive, cannot be repeated frequently, and, in some patients, will
Acknowledgments
The authors thank J.I. Keenan, L. Burgess, and A. Ashcroft at the University of Otago (Christchurch, New Zealand) Gastroenterology Laboratory, who were responsible for the processing and testing of specimens and provided supervision and laboratory support to Emily Wright. The author are grateful to their colleagues and centers for their participation.
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This article has an accompanying continuing medical education activity on page e14. Learning Objective: Upon completion of this exam, successful learners will be able to integrate fecal calprotectin into a management algorithm for patients with Crohn's disease following surgical resection and interpret how these results reflect endoscopic disease recurrence.
Conflicts of interest These authors disclose the following: Peter De Cruz has received travel grant support from Abbott and Schering-Plough; Michael Kamm has acted as an advisor to Abbott and Janssen, has received research support from Abbott, and has acted as a speaker at symposiums sponsored by Abbott and Janssen; Amy Hamilton has received an educational grant from Abbott; Danny Liew has served on advisory boards and received research grants from Abbott; Ian Lawrance has served on advisory boards for Abbott and Janssen, has acted as a speaker for Abbott and Janssen, and has received research and travel grants from Abbott and Janssen; Jane Andrews has been an advisory board member, spoken for, received research funds from, and received travel grants from Abbott and Janssen; Peter Bampton has served on advisory boards for and received travel sponsorship from Janssen and Abbott, and has received research funding from Abbott; Peter Gibson has received consulting fees from Abbott, Janssen, and Schering-Plough, research support from Abbott, and payments for lectures from Abbott and Janssen; Finlay Macrae has served on an advisory board for Janssen, has received travel grants from Abbott, and has received clinical research support from Janssen, Abbott, and MSD; Warwick Selby has served on an advisory board for Abbott; Sally Bell has received travel assistance from Abbott; Steven Brown has received travel support and speaker fees from both Abbott and Janssen; William Connell has served on an advisory board for Janssen and as a speaker for Abbott and Janssen; Andrew Day has served as an advisor to Janssen; and Richard Gearry has served on advisory boards for Abbott and Janssen, as a speaker for Abbott and Janssen, and has received research, educational, and travel grants from Abbott and Janssen. The remaining authors disclose no conflicts.
Funding Research support was provided by the St Vincent’s Research Endowment Fund; Smart-Prep testing kits were provided by Bϋlhmann; and supported by the National Health and Medical Research Council (E.W., P.D.C., and M.A.K.).