Risk Factors for Endoscopic Recurrence After Ileocolonic Resection in Crohn's Disease: A Meta-Analysis

Background: The endoscopic recurrence rate of Crohn's disease after ileocolonic resection is high, yet its predictive factors remain to be systematically established. Therefore, this meta-analysis aimed to comprehensively evaluate risk factors for endoscopic recurrence in this population. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, relevant observational studies were systematically searched across four major medical databases. Random- or fixed-effects models were used to analyze the association of patient, disease, surgical/pathological, and treatment factors with the endoscopic recurrence. Results: Thirty-six studies (6,525 patients) were included. In the primary analysis, significant risk factors included smoking (odds ratio [OR] = 1.52), perianal lesions (OR = 1.50), history of previous bowel resection (OR = 1.44), positive resection margins (OR = 3.26), resection margin inflammation (OR = 2.26), myenteric plexitis (OR = 2.97), and anastomotic ulceration (OR = 2.59). Postoperative drug prophylaxis reduced the risk of recurrence (OR = 0.77), and biologics showed particularly significant effects (OR = 0.67). Age, sex, body mass index, and surgical method had no predictive value. Conclusion: This study identified key risk factors for the endoscopic recurrence of Crohn's disease after ileocolonic resection, providing evidence-based support for individualized postoperative management. Keywords: Crohn's disease; ileocolonic resection; endoscopic recurrence; risk factors; meta-analysis This upload contains supplementary tables, figures, analysis code, and raw data from the meta-analysis.