Abstract Background Growing evidence supports earlier surgery for isolated terminal ileal (TI) Crohn’s disease (CD), yet clinical practice remains variable, with surgery often reserved for medical treatment failure. Through this multicentre mixed-methods study, we aimed to understand the evidence-practice gap by exploring patients’ and clinicians’ perspectives on the role and positioning of bowel resection for surgery-naïve isolated luminal TI CD. Methods Qualitative interviews were previously conducted with healthcare professionals (HCPs) with an interest in inflammatory bowel disease (IBD). We have now conducted a discrete choice experiment with HCPs across the UK to elicit their preferences for an anti-TNF agent versus a laparoscopic ileocaecal resection for treatment-naive localised severe TI CD. We conducted qualitative interviews with patients with TI CD to explore the patient perspective on the acceptability of early surgery, and a survey of patients with a previous ileocolic resection for CD to assess their views on the timing of their first resection. Results The HCP discrete choice experiment (n = 140) revealed theoretical equipoise between the two treatment options. Mucosal healing and avoidance of a high ( = 35%) 5-year risk of resection were the most important factors influencing decision-making. There was strong preference for anti-TNF therapy within a subgroup regardless of the associated outcomes; gastroenterologists and IBD nurses (as opposed to colorectal surgeons) were more likely to belong to that group. Patient interviews (n = 28) revealed that surgery was seen as a last resort measure but patients’ views were shaped by limited and biased information about surgery, often from their clinicians. Of 171 surgical patients, 43% wished they had their first ileocolic resection sooner due to the severity of their symptoms. Decision-regret was low (median 5/100). The only predictor of regret was poor shared decision-making. Conclusion Surgery for isolated TI CD is not offered as an alternative to medical therapy despite supporting evidence. Our previous qualitative interviews with clinicians revealed multiple practical barriers to timely surgery. Data from this study show that strong treatment preferences and professional biases among HCPs also lead to medical therapy being favoured. Patients do not want surgery as primary therapy but equally do not want it as a last resort measure at the cost of quality of life. Patients receive inadequate surgical counselling. Shared decision-making processes should be improved to allow patients to make informed decisions. This can be facilitated through multidisciplinary teamwork and the development of a patient decision-aid. Standardisation of care pathways could minimise variations. References: Ponsioen CY, de Groof EJ, Eshuis EJ, Gardenbroek TJ, Bossuyt PMM, et al. Laparoscopic ileocaecal resection versus infliximab for terminal ileitis in Crohn’s disease: a randomised controlled, open-label, multicentre trial. Lancet Gastroenterol Hepatol. 2017 Nov;2(11):785-792. Husnoo N, Gana T, Hague AG, Khan Z, Morgan JL, Wyld L, et al. Is early bowel resection better than medical therapy for ileocolonic Crohn’s disease? A systematic review and meta-analysis. Colorectal Dis. 2023; 25: 1090–1101 Husnoo N, Morgan JL, Wyld L, Lobo AJ, Brown SR. The challenges of implementing earlier surgery for terminal ileal Crohn’s disease-A qualitative study of the clinician’s perspective. Colorectal Dis. 2025 Feb;27(2):e70027. Conflict of interest: Ms. Husnoo, Nilofer: Research grant from Crohn’s and Colitis UK Wyld, Lynda: No conflict of interest Morgan, Jenna: No conflict of interest Lobo, Alan: No conflict of interest Brown, Steven Ross: No conflict of interest
Husnoo et al. (Thu,) studied this question.