Endoscopic Staple Removal Combined with Biologic Therapy Enhances Postoperative Anastomotic Ulcer Healing in Crohn’s Disease: A Retrospective Cohort Study

Objective This study aimed to evaluate the efficacy and safety of endoscopic staple removal combined with biologic therapy versus biologic therapy alone for postoperative anastomotic ulcers (PAUs) in Crohn's disease (CD). Methods A retrospective analysis was conducted on 77 CD patients diagnosed with PAUs (Rutgeerts score ≥ i2) following ileocolonic resection who received biologic therapy at Nanjing Second Hospital between January 2021 and August 2025. Based on the administration of endoscopic staple removal, patients were categorized into a combination therapy group (Group A, n = 29) and a biologic monotherapy group (Group B, n = 48). The primary endpoint was the endoscopic ulcer healing rate (Rutgeerts score i0-i1) at final follow-up. Secondary endpoints included clinical symptom remission rate, normalization rate of serum CRP (< 5 mg/L), endoscopic remission-free survival, and adverse events. Results Baseline characteristics were comparable between groups. The endoscopic healing rate was significantly higher in Group A than in Group B (82.76% vs. 25.00%, P < 0.001). Analysis of laboratory indicators, presented as median (IQR), demonstrated that Group A achieved significantly greater improvements in Alb (P = 0.014) and ESR (P = 0.013) at follow-up, whereas no significant inter-group differences were observed in the magnitude of change for CRP, Fc, or Hb. Survival analysis revealed a significantly shorter median time to endoscopic healing in Group A (9.2 months vs. not reached, Log-rank P = 0.007). Adverse event rates were comparable. Conclusion Endoscopic staple removal combined with biologic therapy is more effective than biologic therapy alone in promoting endoscopic mucosal healing for PAUs after CD surgery, with a comparable safety profile.