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P193. Long-term incidence and characteristics of intestinal failure in Crohn's disease: A Japanese multicentre study

K. Watanabe1, I. Sasaki1, K. Fukushima2, K. Futami3, H. Ikeuchi4, A. Sugita5, R. Nezu6, T. Mizushima7, S. Kameoka8, M. Kusunoki9, K. Yoshioka10, Y. Funayama11, T. Watanabe12, H. Fujii13, M. Watanabe14, 1Tohoku University Graduate School of Medicine, Surgery, Sendai, Japan, 2Tohoku University Graduate School of Medicine, Laboratory of GI tract reconstruction, Sendai, Japan, 3Fukuoka University Chikushi Hospital, Surgery, Fukuoka, Japan, 4Hyogo College of Medicine, Inflammatory Bowel Disease Center, Nishinomiya, Japan, 5Yokohama Municipal Citizen's Hospital, Surgery, Yokohama, Japan, 6Nishinomiya Municipal Central Hospital, Surgery, Nishinomiya, Japan, 7Osaka University Hospital, Gastroenterological Surgery, Suita, Japan, 8Tokyo Women's Medical University, Surgery II, Tokyo, Japan, 9Mie University Hospital, Gastrointestinal and Pediatric Surgery, Tsu, Japan, 10Kansai Medical University Takii Hospital, Surgery, Moriguchi, Japan, 11Tohoku Rosai Hospital, Surgery, Sendai, Japan, 12The University of Tokyo, Surgical Oncology, Tokyo, Japan, 13Nara Medical University Hospital, Endoscopy, Kashihara, Japan, 14Tokyo Medical and Dental University, Gastroenterology, Tokyo, Japan

Background

Among patients with Crohn's disease (CD) who receive long-term treatment, intestinal failure (IF) is one of the most serious complications. However, there have been few reports concerning the occurrence rate and characteristics of IF in CD patients. The aim of this study was to clarify the risk and characteristics of IF in patients with CD.

Methods

The present study was a retrospective study in 12 hospitals. CD patients who underwent initial surgery at any of the 12 hospitals between 1970 and 2009 were collected (n = 1703). Those who developed IF were reviewed (n = 68), and the cumulative risk of IF was analyzed by Kaplan–Meier method. In addition, IF patients who underwent initial surgery at other hospitals and were then treated at any of the 12 hospitals were also reviewed (n = 33). Thus, a total of 101 IF patients was collected, and the cumulative risk of IF-related death was analyzed.

Definition of IF: CD patients who required intravenous infusion therapy at least twice per week for a period of more than 1 year because of inability to maintain protein-energy, fluid, electrolyte, or micronutrient balance, which resulted from surgical resection were defined as having IF in the present study.. Patients who received intravenous infusion therapy for bowel inflammation, bowel stenosis, fistula, abscess, and/or anal disease were excluded.

Results

The cumulative risk of IF after the initial surgery was 0.8% (5 years), 3.6% (10 years), 6.1% (15 years), and 8.5% (20 years). In CD patients with IF, mean ages at initial surgery, IF occurrence, and at the time of the study were 28.2, 38.2, and 46.1 years, respectively. The mean number of surgeries per patient was 3.3. The mean length of the remnant small bowel was 163cm. Twelve IF patients (12%) had died and the cumulative risk of IF-related death by the time from the occurrence of IF was 1.1% (3 years), 3.7% (5 years), 6.5% (7 years), and 8.9% (10 years). Central venous catheter-related bloodstream infection (CRBSI) and liver dysfunction were the most frequent complications, and the poor prognosis was mainly due to these complications.

Conclusion

The occurrence of IF and IF-related death in CD patients is not rare over the long-term. There is a pressing need to develop strategies for the prevention and management of IF.

# The present study was performed as a project study under the Surgical Research Group, the Research Committee of Inflammatory Bowel Disease, Ministry of Health, Labour and Welfare of Japan.

# A portion of the data from the present study was published in the Journal (Watanabe K, et al. Journal of Gastroenterology, 2013. Epub ahead of print).