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P381. Role of fecal calprotection in predicting ileocolonic endoscopic recurrence in postoperative Crohn's disease

C. Primas1, G. Frühwald1, S. Angelberger1, D. Allerstorfer1, P. Papay1, A. Eser1, C. Gratzer1, C. Dejaco1, W. Reinisch1, G. Novacek1, H. Vogelsang1, 1Medical University of Vienna, Internal Medicin III, Vienna, Austria

Background

Fecal calprotectin nicely correlates with intestinal disease activity in Crohn's disease. It was the aim of this study to evaluate its role in predicting endoscopic recurrence in postoperative Crohn's disease.

Methods

62 patients who underwent ileocolonic resection due to Crohn's disease at the General Hospital of Vienna were prospectively followed up. Ileocolonoscopy was done 6 to 18 months postoperatively and scored after Rutgeerts. Endoscopic recurrence was defined as i2b (at least i2 in terminal ileum) or higher. Endoscopic pictures were reviewed by 2 independent reviewers unaware of the calprotectin results. 5 patients had to be excluded because the terminal ileum had not been reached.

57 patients were evaluated. The median age was 41 (range 22 to 68), 32 male (56.1%), 25 female. Montreal Classification: A2 (35%), A3 (65%); L1 (10%), L2 (15%), L3 (67.5%), L4 (7.5); B1 (2.5%), B2 (40%), B3 (57.5%); none had perianal disease. Stool specimens were collected immediately after surgery and every 3 months until colonoscopy. Calprotectin was measured in stool by a commercial ELISA (Bühlmann Co, Schönenbuch, Switzerland). Disease was considered active if fecal calprotectin was >100 µg/g stool. Statistical analysis was performed using IBM SPSS 20.

Results

Fecal calprotectin collected after a median of 6 months after the surgery (range 3 to 8) was compared with ileocolonoscopy performed median 11 months after surgery (range 5 to 16).

The sensitivity, specificity, positive predictive value, negative predictive value of increased fecal calprotectin for endoscopic recurrence were 93%, 47%, 61%, and 80% respectively. There was a significant association of increased fecal calprotectin and endoscopic recurrence (Chi-square-test, p = 0.001).

Table: Data for 57 patients evaluated
Calprotectin >100 µg/gEndoscopic recurrence
 yes (≥ i2b)no (<i2b)
yes2516
no214

Conclusion

Fecal calprotectin collected at 6 months after surgery may serve as predictive parameter for endoscopic recurrence of Crohn's disease.