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P177. Ileocolonoscopy and small intestine contrast ultrasonography (SICUS) as predictors of clinical outcome after ileo-colonic resection for Crohn's disease: A prospective study at 5 years

S. Onali1, E. Calabrese1, F. Zorzi1, C. Petruzziello1, E. Lolli1, G. Sica2, F. Pallone1, L. Biancone1

1University of Rome Tor Vergata, GI Unit, Medicine, Rome, Italy; 2University of Rome Tor Vergata, GI Unit, Surgery, Rome, Italy

Background: Ileocolonoscopy (IC) is the gold standard for assessing Crohn's Disease (CD) recurrence. Small Intestine Contrast Ultrasonography (SICUS) has been proposed at this purpose. Severe endoscopic recurrence at 1 year (yr) is predictive of poor outcome. The role of IC vs SICUS in the early postoperative period for predicting clinical recurrence in the long term is undefined. We aimed to assess, in a prospective longitudinal study in a cohort of CD patients (pts) undergoing surgery, the correlation between endoscopic and/or sonographic findings at 1 yr and clinical outcome at 4 and 5 yrs.

Methods: All pts undergoing ileo-colonic resection for CD were enrolled from July 2003 to Nov. 2011. After surgery, clinical activity (CDAI) and major treatments (steroids, thiopurines, anti-TNFs) were recorded every year for 5 yrs. IC and SICUS were performed at 1 yr. Recurrence was assessed by IC (Rutgeerts score ≥2) and compatible finding by SICUS included a bowel wall thickness (BWT ≥ 5 mm). Statistical analysis: Pearson Chi-squared test using the Rutgeerts' score (≥2) and/or the BWT (5 ≥ mm) vs clinical relapse (CDAI >150) and/or major treatments.

Results: A total of 37 CD pts (20M, median age 25, range 16–69) were enrolled. Five pts (1.8%) were excluded due to complications (n = 3), lost to follow-up (n = 1), pregnancy (n = 1). At 5 yrs, 32 CD completed the follow up (18M, median age 25, range 16–69): 13 (41%) smokers, 2 (6%) with familial IBD, 19 (59%) stricturing, 13 (41%) penetrating CD. Table 1 summarizes results.

Table 1
Time from surgery1 year1 year1 year4 years5 years
RecurrenceClinical (n = 32)IC (n = 32)SICUS (n = 32)Clinical (n = 32)Clinical (n = 32)
Patients n (%)2 (6%)25 (78%)15 (47%)11 (34%)10 (31%)

At 4 yrs, a significant relation was observed between clinical outcome and both the endoscopic and sonographic (BWT) degree of recurrence when considered either alone or in combination (IC: p = 0.03; SICUS p = 0.04; SICUS+IC p = 0.07; Pearson Chi-Square test). At 5 yrs, any of the above mentioned parameters were significantly correlated

Conclusions: At 1 yr, the severity of endoscopic recurrence and the sonographic assessment of the BWT were predictive of clinical relapse and/or need of major treatments at 4 yrs. Although IC and SICUS show a different view of CD lesions, they both provide useful information regarding the long-term outcome after resection for CD.