Pre-Operative Management of Gastrointestinal Conditions Before Surgery

Inflammatory Bowel Disease (IBD) Management

The European Crohn's and Colitis Organisation recommends that biological treatments can be safely continued during the perioperative period in IBD patients 1, 2
The American Gastroenterological Association suggests that immunomodulators (azathioprine, mercaptopurine, methotrexate) can be continued during the perioperative period as they do not increase postoperative complications 3, 4
The European Crohn's and Colitis Organisation recommends that corticosteroids should be stopped or tapered to the lowest possible dose before surgery, with a target dose of below 20 mg prednisolone or equivalent 3, 5, 6
For patients on steroids during surgery, the American Gastroenterological Association recommends providing intravenous hydrocortisone until oral intake resumes (prednisolone 5 mg = hydrocortisone 20 mg) 5
The European Crohn's and Colitis Organisation suggests implementing standardized steroid-taper protocols postoperatively 5
Tofacitinib requires special consideration due to increased risk of venous thromboembolism; extended thromboprophylaxis is recommended by the American Gastroenterological Association 3

The European Crohn's and Colitis Organisation recommends assessing nutritional status in all IBD patients before elective surgery 3, 7
Malnutrition is more prevalent in active disease and Crohn's disease compared to ulcerative colitis, according to the American Gastroenterological Association 3
The European Society for Clinical Nutrition and Metabolism suggests considering exclusive or partial enteral nutrition for at least 6 weeks preoperatively in patients with penetrating or stricturing Crohn's disease or malnutrition 7
The American Gastroenterological Association recommends correcting anemia preoperatively to reduce risk of postoperative complications 7

The American Gastroenterological Association recommends treating active infections before proceeding with surgery 7

The American Association for the Study of Liver Diseases recommends assessing severity of liver disease using validated scoring systems 8
For patients with liver disease, the American Association for the Study of Liver Diseases suggests providing thromboprophylaxis as these patients have increased risk of thrombosis 3, 8
The American Association for the Study of Liver Diseases recommends considering steroid administration before hepatectomy in normal liver parenchyma to decrease liver injury (avoid in diabetic patients) 8
The American Association for the Study of Liver Diseases suggests ensuring adequate nutritional status; malnourished patients should receive oral nutritional supplements for seven days prior to surgery 8
The American Society of Anesthesiologists recommends limiting preoperative fasting to 6 hours for solids and 2 hours for liquids 8
The American Society of Anesthesiologists suggests considering carbohydrate loading the evening before surgery and 2 hours before anesthesia 8

The American College of Surgeons recommends that thromboprophylaxis is essential, particularly for major hepatectomy and IBD surgery 3, 8
The American College of Surgeons suggests that antimicrobial prophylaxis should be administered as a single dose before skin incision 8

The European Crohn's and Colitis Organisation recommends not abruptly stopping biologics before IBD surgery as this may trigger disease flare 1, 2
The American Gastroenterological Association suggests not continuing high-dose steroids if possible, as they increase risk of infectious complications and anastomotic leaks 3, 6
The European Crohn's and Colitis Organisation recommends not overlooking nutritional assessment in IBD patients, as malnutrition worsens clinical outcomes 3
The American Gastroenterological Association suggests not neglecting extended thromboprophylaxis in patients on tofacitinib 3