Recent studies have found that early endoscopy and timely medication changes reduce the postoperative recurrence rate of Crohn’s more than standard treatment. Seventy percent of patients with Crohn’s (CD) require surgery, and 30 percent experience clinical recurrence within 1 year after surgery. The Australian study divided 174 postoperative CD patients into two groups, with all patients taking metronidazole for 3 months postoperatively, while those at high risk of recurrence were given azathioprine or, if not tolerated, adalimumab. One group of patients (the active treatment group) was reviewed six months postoperatively for endoscopy and stepped up to azathioprine or adalimumab if endoscopic recurrence (Rutgeerts score ≥i2 ) occurred. The other group (standard treatment group) continued with the original drug therapy. The results of the study found that 83% of patients in each group were at high risk of recurrence (presence of 1 or more risk factors: e.g., smoking, penetrating lesions, history of previous surgery, etc.). Of the 122 patients in the active treatment group, 39% required step-up therapy. A postoperative review at 18 months revealed endoscopic recurrence in 49% of the active treatment group compared to 67% in the standard treatment group (p=0.03). The mucosa was completely normal in 22% of patients in the active treatment group compared to 8% in the standard treatment group (p=0.03). The study also found a significantly higher recurrence of endoscopy in patients who smoked. The study suggests the importance of endoscopic evaluation at 6 months postoperatively.