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DOP034. Rutgeerts score and endoscopy based management of postoperative Crohn's disease are useful in patients already receiving pharmacological treatment for recurrence prevention

I. Blazquez1, Y. Gonzalez-Lama1, C. Suarez1, V. Matallana1, M. Calvo1, V.M. Isabel1, L. Abreu1, 1Hospital Universitario Puerta de Hierro Majadahonda, Gastroenterology, Majadahonda, Spain

Background

Rutgeerts score was designed to predict the course of postoperative Crohn's disease (CD) and is currently used to establish the need of postoperative treatment for recurrence prevention (TPR). Usefulness of endoscopy-based management of patients who are already receiving TPR is yet to be proved. Whether or not Rutgeerts score is a useful tool in this scenario remains unclear.

Aims:

  • To assess the course of the disease in CD patients who have undergone ileocecal resection and receive pharmacological treatment to prevent PR
  • To evaluate the usefulness of an endoscopy and Rutgeerts score based management of postoperative CD patients who are already receiving treatment to prevent PR

Methods

Retrospective review of clinical outcome along the follow up of all CD patients with ileoceal resection; only considered for the analysis patients who have gone through a postoperative colonoscopy in the last 9 years at our centre. Postoperative endoscopy findings were classified as low risk (Rutgeerts i0-i1) or high risk (Rutgeerts i2-i4) We considered as “Endoscopy-based management (EBM)” if the treatment was escalated in the presence of high-risk endoscopy findings and was not escalated in the presence of low-risk endoscopy findings. We considered the rest of the cases as “non endoscopy-based management (NEBM)”. To assess the efficacy of those different strategies, we considered the time until clinical recurrence or the end of the follow up.

Results

166patients were included. 77% were under pharmacological treatment to prevent PR at the time of the colonoscopy: 34% aminosalicylates, 50% thiopurines, 11% anti-TNF, 5% combo therapy. In those patients, colonoscopy showed low-risk findings (Rutgeerts score i0–i1) in 43%, and high-risk findings (Rutgeerts score i2–i4) in 57%. No statistically significant differences were found with the group of the patients that were under no treatment to PR. Regarding those patients with EBM, the proportion of patients with low-risk who remain in clinical remission was 89%, 79%, 74%, 71% and 71% at the 1st, 2nd, 3th, 5th and 9th year respectively; the proportion of patients high-risk who remain in clinical remission was 70%, 62%, 60%, 58% and 58% at the 1st, 2nd, 3th, 5th and 9th year respectively. Despite the EBM, patients with high-risk endoscopic findings did worse than patients with low-risk endoscopic findings (p = 0.01).

Patients with high-risk and NEBM did worse than patients with EBM (p = 0.012), and as much as 50% of the patients with high-risk who were receiving treatment to prevent PR and did follow a NEBM presented clinical recurrence before 2 years of follow up.

Conclusion

Despite receiving pharmacological treatment to prevent PR, CD patients should follow an endoscopy-based management, and Rutgeerts score is useful also in this scenario.