Prevention of Postoperative Endoscopic Recurrence with Endoscopy-driven Versus Systematic Biological Therapy

This study is comparing two approaches to preventing Crohn's disease from coming back in the gut after bowel surgery: starting a biologic medication only when endoscopy (a camera procedure) shows early signs of recurrence, versus giving biologics to everyone routinely. The goal is to find the most effective strategy with the least unnecessary treatment. **You may be eligible if...** - You are 18–80 years old with a confirmed diagnosis of Crohn's disease - You have had surgery to remove part of your bowel (ileocolonic resection) within the past 3–40 days - You are at higher-than-average risk of disease coming back after surgery (e.g., due to penetrating disease, previous surgery, active smoking, or recent biologic use) - You have previously tried steroids or immunosuppressants for at least 3 months **You may NOT be eligible if...** - You are not at high risk for post-surgical recurrence - You cannot tolerate the study drug options - You are pregnant or planning to become pregnant - You have active serious infections Talk to your doctor to see if this trial is right for you.