This article is the second in a series of two publications relating to the European Crohn’s and Colitis Organisation [ECCO] evidence-based consensus on the management of Crohn’s disease. The first article covers medical management; the present article addresses surgical management, including preoperative aspects and drug management before surgery. It also provides technical advice for a variety of common clinical situations. Both articles together represent the evidence-based recommendations of the ECCO for Crohn’s disease and an update of previous guidelines.
The incidence and prevalence of Crohn’s disease [CD] is rising globally, with yearly increases in incidence ranging from 4% to 15% over the past three decades.1 A cure remains elusive, and efficient management of CD is essentially multidisciplinary and interprofessional. At least half of patients with CD undergo one or more surgical procedures during their lifetime. CD patients frequently suffer from malnutrition and psychological comorbidities, and may have to live with a stoma.2–5 Care for CD has become more complex for both medical and surgical disciplines. Several new drugs have entered the market, and surgical subspecialisation for inflammatory bowel disease has evolved. The best possible outcomes are currently achieved within dedicated expert centres providing personalised medicine.6–10 Care for CD is exemplary in an interrelated clinical world where the actions of individual health care providers need coordination, common knowledge, and shared expectations to optimise clinical management and research in terms of diagnosis, treatment, and side-effects. The European Crohn’s and Colitis Organisation [ECCO] provides an interdisciplinary framework with the present evidence-based Consensus Guidelines to inform and guide clinicians and allied health care providers caring for patients with CD. The present Guidelines focus on surgery for CD, including preoperative aspects and drug management before surgery, and provide technical advice for a variety of common clinical presentations. Further guidance on most aspects of interdisciplinary and interprofessional care for CD has been elaborated by ECCO in separate publications.3,11–16