P323. Post-operative Crohn's disease: Are we following ECCO guidelines?
S. Butt1, H. Dhutia1, A. Joshi2, K. Besherdas1
1Chase Farm Hospital, Gastroenterology, Middlesex, United Kingdom; 2Chase Farm Hospital, Pathology, Middlesex, United Kingdom
Background: Approximately 50% of patients with Crohn's Disease (CD) will require resection within 10 years while 80% will require surgery by 20 years. The most common indications for surgery are failure of medical therapy and intestinal obstruction. Unfortunately, surgery is not curative as the disease often recurs in many patients. Data from endoscopic follow-up of patients after resection have shown that in the absence of treatment, the post-operative recurrence rate is around 65 to 90% within 12 months and 80–100% within 3 years. Clinical recurrence without therapy is about 20 to 25%/year. The ECCO Consensus outlines management goals for post-op patients.
Methods: The aim was to analyse how medical and surgical colleagues manage post-operative CD in comparison to ECCO guidance. This was a retrospective assessment of all patients that underwent a small/large bowel resection for CD. Patients were isolated by obtaining a list of patients with resected specimens identifying CD on histology. Patient notes were studied to investigate operation details, maintenance treatment and follow-up arrangements including ileocolonoscopy.
Results: A total of 26 patients were found to have histological specimens with CD post operatively during the period 2005 to 2010. Out of these 21 patients records could be obtained for study. Age range was 18 to 80 with male to female ratio 14:7. 14/21 (67%) operations included terminal ileal resections. 6/21 (29%) patients were on no prophylaxis post-operatively at all. 9/21 (43%) were on thiopurine maintainance, 3/21 (14%) were on mesalazine alone, 1 on methotrexate, 1 on infliximab and 1 on mesalazine with metronidazole. Only 3/14 (21%) patients with terminal ileal resections were on B12 supplements. Follow up endoscopy occurred in 7/21 (33%) and ranged from 3 months to 30 months from operation date. Follow up clinic appointments occurred between 1 month to 12 months from the operation date and smoking advise was documented in 13/21 (62%) patients.
Conclusions: This study demonstrates the variability of management of patients with CD post-operatively. Our results show that nearly 30% patients continue to remain on no maintenance therapy after their operation. In addition, only a third of patients undergo colonoscopies to review their disease status/anastomosis and this can be as late as 2.5 years post-op. Smoking advice was not documented in over a third of patients and a very small number of terminal ileal resected patients were on any supplement therapy.