P321. Recurrence of Crohn's disease after definitive stoma: A retrospective study in 83 patients
D. Koriche1, J. Salleron2, C. Gower-Rousseau3, A. Cortot4, J.‑F. Colombel5, P. Zerbib6
1Lille University Hospital Nord de France, Surgical Unit, Lille, France; 2Lille University Hospital, Epidemiology Unit, Lille, France; 3Lille University Hospital, Epidemiology Unit, EPIMAD Registry, Lille, France; 4Lille University Hospital, Lille, France; 5Centre Hospitalier Universitaire de Lille, Hôpital Claude Huriez, Lille, France; 6Lille University Hospital Nord de France, Adult Surgical & Transplantation, Lille, France
Background: The need for a definitive bowel stoma (DS) is considered as the ultimate phase of damage in Crohn's disease (CD). It is often believed that, after a DS has been performed for disease control, the risk of disease recurrence is small but few data are available. The aims of this study were to describe the phenotypes at diagnosis and disease outcome in patients having had a DS for CD.
Methods: We retrospectively collected clinical data at diagnosis and at follow-up of patients with CD diagnosed between 1973 and 2010 that had a DS. Stoma was considered as definitive when restoration of continuity was not possible due to protectomy, severe anoperineal lesions (APL), proctitis, or faecal incontinence. Surgical recurrence was defined as a need for a new intestinal resection. Clinical recurrence was defined as the need for re-introduction or intensification of medical therapy.
Results: 83 patients (20 M, 63F) with a median age of 22.7 years [3.4–72.6] at CD diagnosis were included. Disease location at diagnosis was pure ileal (L1) in 4% of patients (n = 3), pure colonic (L2) in 46% (n = 38) and ileocolonic (L3) in 50% (n = 42). The median times between diagnosis and DS and maximal follow up after DS were 9.1 years [0–34.8] and 5.2 [0.0–24.3], respectively. The indication for DS was intractable APL in 59% (n = 49), refractory colitis or proctitis in 36% (n = 30) and anal incontinence in 28% (n = 23). Before DS was performed, 17 patients (20%) had one intestinal resection and 28 (34%) two or more intestinal resections. Before DS was performed, 54 patients (65%) received at least one immunosuppressor and 30 (36%) at least one anti‑TNF agent. During the follow-up after DS, 50 patients (60%) needed a new intestinal surgery after a median time of 2.4 years [0.0–17.7] including a resection for CD recurrence above the DS in 22 patients (44%) and a resection of the diverted segment in 28 (56%). Twenty-seven patients (32%) presented a clinical recurrence after a median time of 1.7 years [0.0–17.6]. The frequency of surgical recurrence above the DS was significantly lower in patients with pure colonic CD (L2) than in those with ileocolonic CD (L3) (16% vs 40%; p < 0.03). There was no difference in smoking habits between the patients with surgical recurrence and those not operated.
Conclusions: In patients with CD having had a DS, CD may still recur and lead to an iterative surgery. Preventive therapeutic strategies are warranted in these patients.