Ileocecal resection vs infliximab for terminal ileitis

What is known

• The LIR!C RCT found similar quality-of-life outcomes between laparoscopic ileocaecal resection and infliximab. ^1,2
• Long-term follow-up reported durable therapy-free and clinical remission after upfront resection, versus ongoing anti-TNF need in the infliximab arm. ^2,3
• Resection was cost-effective relative to infliximab in the LIR!C economic analysis. ⁴

What is unknown / caveats

• Long-term follow-up analyses were retrospective extensions of the trial
• LIR!C enrolled uncomplicated ileocaecal disease failing conventional therapy. Findings may not generalise to complicated/penetrating phenotypes
• Exact remission and therapy-free percentages not quoted in retrieved excerpts
• The retrieved excerpts confirm comparable QoL and durable therapy-free remission after surgery but do not provide the precise numeric remission rates.

References

1. Ponsioen CY, de Groof EJ, Eshuis EJ, Gardenbroek TJ, Bossuyt PMM, Hart A, Warusavitarne J, Buskens CJ, van Bodegraven AA, Brink MA, Consten ECJ, van Wagensveld BA, Rijk MCM, Crolla RMPH, Noomen CG, Houdijk APJ, Mallant RC, Boom M, Marsman WA, Stockmann HB, Mol B, de Groof AJ, Stokkers PC, D'Haens GR, Bemelman WA, LIR!C study G. Laparoscopic ileocaecal resection versus infliximab for terminal ileitis in Crohn's disease: a randomised controlled, open-label, multicentre trial. Lancet Gastroenterol Hepatol. 2017;2(11):785-792. PMID: 28838644.

2. Stevens TW, Haasnoot ML, D'Haens GR, Buskens CJ, de Groof EJ, Eshuis EJ, Gardenbroek TJ, Mol B, Stokkers PCF, Bemelman WA, Ponsioen CY, LIR!C study G. Laparoscopic ileocaecal resection versus infliximab for terminal ileitis in Crohn's disease: retrospective long-term follow-up of the LIR!C trial. Lancet Gastroenterol Hepatol. 2020;5(10):900-907. PMID: 32619413.

3. Oldenburg L, Haanappel AEG, Ali M, Bosman C, Buskens CJ, Ponsioen CY, D'Haens GR, Bemelman WA, LIR!C study G. Ileocaecal resection versus infliximab for ileal Crohn's disease: retrospective 10-year follow-up of the LIR!C trial. Lancet Gastroenterol Hepatol. 2026;11(4):314-322. PMID: 41724174.

4. [No authors listed]. State-of-the-art surgery for Crohn's disease: Part I-small intestine/ileal disease. Langenbecks Arch Surg. 2022;407(3):885-895. PMID: 34738167.

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Draft, generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct.