What question did this study set out to answer?

This study aims to develop and validate the PROSPER endoscopic score for predicting post-operative recurrence in Crohn's disease.

January 23, 2026

P0194The PROSPER endoscopic score: An advanced imaging tool for early detection of post-operative recurrence in Crohn’s disease

Key Points

This study aims to develop and validate the PROSPER endoscopic score for predicting post-operative recurrence in Crohn's disease.
International multicentre prospective study
Enrollment of adult Crohn's disease patients post-ileocolic resection
Endoscopic assessment with white-light and virtual chromoendoscopy at 3 or 6 months after surgery
Three-round modified Delphi process with expert consensus
Assessment of mucosal and vascular features in multiple regions of the colon and anastomosis
Moderate to substantial inter-rater agreement for features in the neo-terminal ileum and colon proximal to the anastomosis
Higher reproducibility for ulcers and vascular patterns
Consensus with over 80% expert agreement on selected domains of the PROSPER score
The score shows feasibility for detecting early post-operative recurrence

Abstract

Abstract Background Post-operative recurrence (POR) of Crohn’s disease (CD) remains a major challenge, affecting up to 80% of patients within 10 years after surgery. Conventional endoscopy struggles to distinguish early inflammatory recurrence from post-surgical ischaemic changes, delaying effective treatment. Virtual chromoendoscopy (VCE) offers precise visualisation of mucosal and vascular changes. The PROSPER study aims to develop and validate a novel endoscopic score integrating advanced imaging features to predict early POR in CD. Methods This analysis is part of the international, multicentre, prospective PROSPER study (NCT06505304). Adult CD patients undergoing ileocolic resection were enrolled pre-operatively or within 3 months post-operatively and underwent endoscopic assessment at 3 or 6 months after surgery, guided by faecal calprotectin levels (cutoff 150 µg/g). Endoscopic videos were obtained using white-light and VCE modalities —TXI, RDI, and NBI with the Olympus (EVIS-X1) platform, and i-scan1 and OE mode 1–2 with the Pentax (INSPIRA) platform— following a standardised protocol. A three-round modified Delphi process defined the PROSPER domains: two in-person consensus meetings and an online survey (Qualtrics platform) where experts rated each feature. Consensus required 75% agreement. Seven core experts participated in both the first (10 videos) and second (15 videos) rounds, scoring the colon proximal to the anastomosis, the anastomotic region (including anastomotic line, ileal inlet, ileal body, and, when present, blind loops), and the neo-terminal ileum. All anastomotic configurations -end-to-end, end-to-side, side-to-end, side-to-side, and Kono-S- were assessed (Fig 1). Inter-rater agreement was evaluated using Fleiss’ κ, Gwet’s AC1/AC2, and ICC(2,k). Results Mucosal and vascular domains were selected, including erosions, superficial and deep ulcers, villi morphology, vessel dilatation, and bleeding (Tab 1). Agreement across both in-person rounds was moderate to substantial for features in the neo-terminal ileum and colon proximal to the anastomosis (AC1/AC2 = 0.61–0.78) and lower for the anastomotic region (fair to moderate), particularly for villi and erosions (AC2 ≈ 0.40–0.50). Ulcers and vascular patterns showed higher reproducibility (AC1 ≈ 0.70–0.80). Moderate agreement was observed for the anastomosis type (κ 0.51). The Delphi survey confirmed selected domains, with over 80% expert agreement on inclusion and weighting. Conclusion The novel PROSPER score is a multimodal tool integrating advanced imaging for comprehensive assessment of the anastomosis, showing good inter-expert agreement across most domains. These results support its feasibility for detecting early POR. The next phase will involve real-life validation. Conflict of interest: Iacucci, Marietta: Grant: Pentax, Olympus, Eli lilly, Helmsley Personal Fees: Pentax, Pfitzer, Janssen, EliLilly, J&J Dr. Santacroce, Giovanni: No conflict of interest Zammarchi, Irene: No conflict of interest Nardone, Olga Maria: Advisory board fees from Eli Lilly, Nestlè, Janssen Speaker fees from AbbVie, Janssen, Eli Lilly, Ferring, Alfa Sigma, Recordati, Noòs, and Pfizer Cannatelli, Rosanna: No conflict of interest Doherty, Glen: Research or Education Grants (last 36 months):Abbvie, Pfizer, Janssen, Takeda, Tillotts, Celltrion, Abbott, Dr Falk, Amgen Speaker/Meeting Honoraria (Last 36 months):Abbvie, Dr Falk, Galapagos/Alfa Sigma, GSK Furfaro, Federica: Grant: IG-IBD Personal Fees: Pfizer, Biogen, J&J, Abbvie, Amgen, Janssen Gabbiadini, Roberto: No conflict of interest Lu, Cathy: Advisory board - Abbvie, JnJ, Takeda, Ferring, Merck, Celltrion, Pfizer Research Funding - Abbvie, JnJ Pugliano, Cecilia Lina: No conflict of interest Snir, Yifat: No conflict of interest Ghosh, Subrata: No conflict of interest Tontini, Gian Eugenio: • Speaker honoraria from Pentax (2022), Medtronic (2021), NTC Pharma (2021), Ferring (2024) • Consultant fees from NTC Pharma (2022, 2024), F. Hoffmann-La Roche Ltd (2022), Fujinon (2023), Invicro (2025). Bisschops, Raf: Grant: Pentax Europe, Medtronic, Norgine Personal Fees: Pentax Europe, Fujifilm, Norgine, Medtronic, Ipsen, Alfasigma, Viatris, Endostart, Falk Foundation Non-financial Support: Pentax Europe, Fujifilm, Boston Scientific, Olympus, Erbe, Norgine

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Cite This Study

Iacucci et al. (Thu,) studied this question.

synapsesocial.com/papers/69731047c8125b09b0d1ff71 https://doi.org/https://doi.org/10.1093/ecco-jcc/jjaf231.375

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