P645 Ileocecal resection in paediatric Crohn’s disease based on the Hungarian Paediatric IBD Registry
Müller, K.(1,2);Bajzat, D.(1,3);László, S.S.(4);
(1)Heim Pal National Institute for Pediatrics, Gastroenterology, Budapest, Hungary;(2)Faculty of Medicine- University of Pécs, Institute for Translational Medicine, Pécs, Hungary;(3)Semmelweis University, Institute for Translational Medicine, Budapest, Hungary;(4)University of Debrecen, Pediatrics Clinic, Debrecen, Hungary; HUPIR Group
Background
Despite optimized treatment, almost one-third of the patients with IBD develop
complications such as fistulae, strictures, and abscesses, thus need surgical treatment within 5 years of diagnosis. In paediatric Crohn’s disease surgery may be considered when a patient has active disease despite optimized medical treatment.
The aim of our study was to evaluate the practice of surgical interventions in paediatric Crohn’s disease regarding indications, postoperative therapy and follow-up endoscopy in Hungary.
Methods
We performed a retrospective analysis based on the database of the Hungarian Paediatric IBD Registry (HUPIR). The HUPIR is a prospective, nationwide registry launched in 2007. Data of patients who underwent ileocecal resections between January 2010 and December 2019 were included in the analysis. We applied descriptive statistical methods to characterise the cumulative incidence of surgical resections, the urgency of the interventions, postoperative complications and follow-up endoscopies.
Results
Altogether 943 newly diagnosed CD patients were reported between 2010 and 2019, among them 55 (6%) had ileocecal resection of 99 children with CD who underwent (10%) surgical interventions within 2.15 years mean follow-up period. Surgical data of ileocecal resections were available in 47 (85%) cases (mean age: 14.5 years, male:20). Disease localization at diagnosis was ileocecal in 38% and ileocolonic in 40.2%. The mean time between diagnosis and surgical intervention was 21.2 months (0-62). The ileocecal resection was elective in 37 (78.7%), and laparoscopic resection was performed in 17 cases (36%). Frequency of early postoperative complication was 8.5% (4/47), which was not associated with the urgency of the intervention, the technique, preoperative corticosteroid or anti-TNF treatment. Only the third of the patients (17/47, 36%) had colonoscopy within 6 months after resection.
Conclusion
Based on the HUPIR the number of surgical ICR is lower than in earlier reports reflecting a different approach. The early complication rate was low despite the low number of interventions. In a middle-income country, it is a question why surgical intervention are lower compared to international. Paediatric gastroenterologists seem to prefer conservative therapy probably due to the lack of experienced paediatric IBD surgeons.