OP18. Long-term outcome after first intestinal resection in paediatric-onset Crohn's disease: A population-based study
M. Boualit1, J. Salleron2, D. Turck2, M. Fumery3, G. Savoye4, J.‑L. Dupas5, E. Lerebours6, A. Duhamel2, V. Merle7, A. Cortot8, J.‑F. Colombel9, L. Peyrin-Biroulet10, C. Gower-Rousseau11
1University Hospital, Gastroenterology, Lille, France; 2Lille University Hospital, Epidemiology Unit, Lille, France; 3Amiens University and Hospital, Gastroenterology, Amiens, France; 4Hôpital Charles Nicolle, Department of Gastroenterology, Rouen, France; 5Amiens University Hospital North Hospital, Dept. of Hepagastroenterology, Amiens, France; 6Hôpital Charles Nicolle, Rouen, France; 7Hospital and University, Rouen, France; 8Lille University Hospital, Lille, France; 9Centre Hospitalier Universitaire de Lille, Hôopital Claude Huriez, Lille, France; 10University Hospital of Nancy, Hepato-Gastroenterology, Vandoeuvre-Lès-Nancy, France; 11Lille University Hospital, Epidemiology Unit, EPIMAD Registry, Lille, France
Background: Surgery is considered as a predictor of bad prognosis in patients with Crohn's disease (CD) who already present with complications at diagnosis. Objective: To describe the postoperative course and identify predictors of outcome after first intestinal resection in paediatric-onset CD.
Methods: In a population-based incidence cohort (19882004), among 404 CD patients (017 years) with a follow-up time greater than 2 years, 130 underwent an intestinal resection. Cumulative probability of second resection and first need for immusuppressors (IS) and/or biologics were estimated through Kaplan Meier analysis. The martingal residuals of the Cox model determined the threshold for age (14 years) and time for first resection (3 years). Cox models were used to determine predictors of each outcome. Impact of time of first surgery on nutritional and growth catch-up was studied using a linear regression
Results: 130 patients (70 F) with a median age at diagnosis of 14.5 years  were followed for 13 years [9.416.6]. Cumulative probability of second resection was 8%, 17% and 29% at 2, 5 and 10 years, respectively. In multivariate analysis, age <14 years, severe behaviour and L4 location at diagnosis were significantly associated with an increased risk of second resection. Cumulative probability of receiving IS or biologics was 19%, 39% and 55% at 2, 5 and 10 years, respectively. In multivariate analysis L4 location at diagnosis was a risk factor for need for IS or biologics while surgery within 3 years after CD diagnosis was protective. Catch-up of height and weight were significantly better in patients with the first surgery within 3 years after diagnosis.
Conclusions: In this paediatric-onset CD population-based study, early first surgery was associated with a reduced need for IS or biologics and a better catch-up of height and weight. Severe behaviour and L4 location at diagnosis were associated with an increased risk of second resection.