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P136. Simple endoscopic score for Crohn's disease (SES-CD) predicts long-term prognosis in Crohn's disease patients with clinical remission

M. Naganuma1, N. Inoue2, K. Matsuoka3, T. Hisamatsu3, Y. Iwao2, T. Kanai3, H. Ogata1, 1Keio University, Center for Diagnostic and Therapeutic Endoscopy, Tokyo, Japan, 2Keio University School of Medicine, Center for Preventive Medicine, Tokyo, Japan, 3Keio University, Gastroenterology and Hepatology, Tokyo, Japan

Background

Mucosal healing (MH) has correlated to short-term and long-term prognosis of Crohn's disease (CD). MH has also merged as a desirable treatment goal in clinical practice in patients with CD. The aim of this study is to assess the usefulness of SES-CD in predicting outcome of CD patients with clinical remission.

Methods

We conducted a retrospective cohort study in clinical practice at a single center. Among CD patients who underwent colonoscopy at our hospital, 128 patients were enrolled. Among these, 83 patients were in clinical remission. Patients with ileostomy/colostomy or severe anal lesion/stenosis were excluded. Clinical characteristics, endoscopic activity, and clinical outcome after colonoscopy for at least 12 months were collected from medical records. Clinical remission was defined that Harvey–Bradshaw index (HBI) was 0 or 1 and clinical relapse was defined as HBI ≥4 at a visit. Endoscopic activity was graded according to SES-CD. Association between variables and clinical relapse was evaluated by univariate and multivariate analyses using Cox regression model. Cumulative non-relapse rate was calculated using Kaplan–Meier survival analysis and compared among groups using log-rank test.

Results

Over a mean follow-up of 23.5 months (range 12–60), 32 patients (39%) experienced clinical recurrence, 6 patients needed hospitalization and 2 underwent surgery. Mean SES-CD at entry was significantly higher in patients who were relapsed than that who maintained remission (7.8 vs. 1.6, p < 0.01). ROC curve analysis to determine cut-off value of SES-CD indicated that sensitivity and specificity for clinical relapse was 84% and 75% when cut-off value was 2.5 (AUC 0.84). Univariate analysis identified that clinical remission was significant associated with SES-CD ≤2, normal CRP levels, and maintenance with infliximab. The cumulative non-relapse rate was 33% in patients whose SES-CD was ≥3 whereas it was 88% in patients whose SES-CD was ≤2 (p < 0.01). This tendency was observed both in patients who were treated with/without biologics. Cox regression analysis after adjustment of possible confounding factors revealed that SES-CD ≤2 was found to be independent determinants of non-relapse (HR 0.17; 95% CI 0.06–0.48).

Conclusion

The present study demonstrated that endoscopic remission (SES-CD ≤2) predicted long-term prognosis even in patients with clinical remission.