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P233. Early measurement of fecal calprotectin after intestinal resection is useful to predict postoperative recurrence in patients with Crohn's disease

M. Laidet1, G. Boschetti1, G. Phelip1, A.-L. Charlois1, C. Menard1, J. Drai2, B. Flourié1, S. Nancey1, 1Hospices Civils de Lyon, Lyon-Sud hospital, Gastroenterology, Pierre Benite, France, 2Hospices Civils de Lyon, Lyon-Sud hospital, Biochemistry, Pierre-Benite, France

Background

Endoscopic recurrence is common after intestinal resection in Crohn's disease (CD) and its detection is predictive of further clinical recurrence. Fecal calprotectin (fCal) concentrations that have been extensively reported to strongly correlate with CD activity may be valuable to predict postoperative recurrence in patients who undergo an intestinal resection. AIMS: To determine the usufulness of fCal measured (as early as 3 months post-surgery) to identify CD patients at high risk of post-operative recurrence within one-year post-resection.

Methods

Twenty-two consecutive CD patients (15F, median age 32 yrs) who underwent a curative ileo-colonic resection were prospectively followed during one year post-surgery by recording every 3 months the clinical disease activity index (Harvey–Bradshaw) and by performing at 6 months (and also at 12 months post-surgery in the absence of endoscopic recurrence at 6 months) an ileo-colonoscopy. A stool sample was collected 3 months post-surgery and fCal concentrations were measured by ELISA assay (Bühlmann, Schönenbuch, Switzerland). Clinical and endoscopic recurrences were defined as a HBI >4 points and a Rutgeerts severity score ≥i2, respectively. Statistical analysis included comparisons of fCal concentrations using a Mann–Whitney test, Spearman correlations and the construction of a ROC curve.

Results

None of the patients experienced a clinical recurrence within one-year post-surgery. Cumulative rates of postoperative endoscopic recurrence at 6 and 12 months post-resection were 46% and 73%, respectively. A moderate (Rutgeerts i2) and a severe (Rutgeerts ≥i3) endoscopic recurrence were identified in 9 and 7 patients, respectively. Fecal calprotectin levels measured at 3 months post-surgery were significantly higher in patients who further experienced a postoperative endoscopic recurrence when compared with those in patients who stay in remission (mean±SD 1028±2481 g/kg vs 92±19 g/kg; p < 0.05). The area under the ROC curve (AUC) for fCal levels measured at 3 months post-surgery to discriminate patients at high risk of endoscopic recurrence from those in remission within one year was 0.80. Using the best cutoff point for fCal levels of 140 g/kg determined by the ROC curve, sensitivity, specificity, positive and negative predictive values as well as overall accuracy were 100%, 55%, 67%, 100% and 76%, respectively.

Conclusion

Measurement of fCal concentrations, as early as 3 months post-surgery, may be useful for identifying CD patients at high risk of endoscopic recurrence within one-year post-surgery and subsequently may help clinicians to manage therapy in the postoperative setting.