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P294. Yield of colon surveillance and clinical outcome after faecal diversion in patients with Crohn's disease

D. van den Nieuwendijk1, C.I. Baeten2, J.C. Hardwick1, R.A. Veenendaal1, A.R. Vahrmeijer2, B.A. Bonsing2, A.E. van der Meulen-de Jong1, 1Leiden University Medical Center, Gastroenterology and Hepatology, Leiden, Netherlands, 2Leiden University Medical Center, Surgery, Leiden, Netherlands

Background

Recently, a number of patients with Crohn's disease (CD) were identified at the gastroenterology outpatient clinic in the University Medical Centre in Leiden with complaints about their (partly) deviated colon after having a stoma construction. Meanwhile, the excluded colon was no longer accessible for surveillance by endoscopy because of stenosis. Aim of this study was to get a better insight into the distal colon after faecal diversion in Crohn's patients, mainly focussing on the implications for the excluded colon and the risk of developing colorectal cancer.

Methods

A retrospective study was performed in a cohort of patients with CD who received a stoma between 2003–2012 at Leiden University Medical Centre. The patients' medical records were thoroughly examined and information about the clinical outcome and yield of surveillance of the deviated colon was obtained. A stoma was regarded as permanent when the anal sphincter had been surgically removed; a stoma was regarded as non-permanent when the anal sphincter was in situ and reconstruction of bowel continuity was still an option. Follow-up time was since reconstruction of first stoma till loss of follow-up or till the end of this study; 1 March 2013.

Results

Seventy-four CD patients who had received a stoma were included in the study. The cumulative follow-up time since the first stoma construction was 658.8 years (mean 8.9 years). At the end of follow-up, 27.1% of the patients had bowel continuity, 39.2% had an non-permanent stoma in situ and 32.4% had a permanent stoma. Clinical outcome was unknown in one patient (1.4%). Indications for diversion of the faecal stream were: refractory disease (RD) (28.4%); fistulas and/or stenosis (32.4%); a combination of RD with fistula and/or stenosis (16.2%); dysplasia/malignancy (8.1%); complications after surgery; i.e. suture leakage (8.1%) and other (6.8%). According to the physician, the initial indication for diversion was solved in 54.7% of the patients. The indications ‘RD’ and ‘fistulas’ had the most unfavourable prognosis in our cohort (respectively 52.4% and 33.3% recovery). In 93.3% of the cases, surveillance of the deviated colon was in accordance with the current surveillance guidelines (AGA and BSG). No dysplasia or malignancies in the deviated colon were found in our population (cumulative follow-up time with a stoma in situ: 238.8 years).

Conclusion

In more than half of the patients with CD, the initial indication for the stoma was solved by diversion of the faecal stream. Dysplasia or colorectal cancer did not occur in the excluded (part of the) colon in our series and we are convinced that this is a rare incident in patients with CD and faecal diversion.