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P252. Correlation between severity of endoscopic lesions and clinical activity in a cohort of Crohn's disease patients followed up for 5 years after ileo-colonic resection

S. Onali, E. Calabrese, C. Petruzziello, G. Condino, M. Ascolani, E. Lolli, F. Pallone, L. Biancone, Gastroenterology Unit, University of Rome Tor Vergata, Department of Systems Medicine, Rome, Italy

Background

Ileocolonoscopy (IC) represents the gold standard for assessing Crohn's Disease (CD) recurrence. Small Intestine Contrast Ultrasonography (SICUS), is a non invasive technique visualizing small bowel lesions in CD. The predictive role of severe endoscopic recurrence at 1 year for subsequent clinical recurrence at 3 years has been demonstrated, while the longer term predictive role of IC for predicting the clinical outcome of CD patients (pts) after surgery is undefined. In a prospective longitudinal study, we aimed to assess, in a cohort of CD pts undergoing ileo-colonic resection, possible correlations between the endoscopic score of recurrence at 1 year and clinical activity assessed yearly for up to 5 years.

Methods

At this purpose, from July 2003 to Feb. 2012, 40 CD pts undergoing ileo-colonic resection were enrolled. IC and SICUS were performed at 1 yr and pts were prospectively followed up for 5 years, with clinical activity (CDAI) assessed yearly for 5 years. At 1 year, recurrence was assessed by IC (Rutgeerts ≥2) and SICUS (wall thickness ≥3 mm). Data were expressed as median (range). Correlations between the endoscopic score and CDAI were assessed by the Spearman correlation test.

Results

CD group included 40 pts (23M, age 30 yrs, range 16–69), with stricturing (25/40; 63%) or penetrating CD (15/40; 37%). Among risk factors for recurrence, 16 (40%) pts were smokers, familial history of IBD was shown by 3 pts (8%). The Table summarizes the proportion of pts with endoscopic and SICUS findings compatible with recurrence at 1 yr and with clinical recurrence in the 5 years follow up. When the severity of endoscopic recurrence at 1 year was correlated with the CDAI score, a significant correlation was observed with the CDAI score at 2 yrs (p = 0.007; r = 0.41), while no significant correlation was observed with the CDAI score at 1, 3, 4 and 5 years (p = 0.23, r = 0.19; p = 0.52, r = 0.10; p = 0.86, r = 0.02; p = 0.41, r = 0.13, respectively). In our study population, a low frequency of clinical recurrence was observed at 5 years (16/40; 40%).

Table: Proportion of patients (N = 40) with endoscopic and SICUS findings compatible with recurrence at 1 year and with clinical recurrence in the 5 years of follow up
Recurrence, n (%)
ClinicalICSICUS
1 year3 (7.5%)31 (78%)24 (60%)
2 years10 (25%)
3 years5 (13%)
4 years3 (7.5%)
5 years5 (13%)

Conclusion

In a cohort of CD patients followed up for 5 years after ileo-colonic resection, the severity of endoscopic recurrence at 1 year was predictive of clinical relapse at 2 years, but not at subsequent longer term follow up.