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P511. Does the location of an IBD centre impact the rates of early postoperative endoscopic recurrence after ileocecal resection in Crohn's disease? Results from the MULTIPER database

P.G. Kotze1, T. Yamamoto2, S. Danese3, Y. Suzuki4, I. Albuquerque5, I. Barcelos1, L. Kotze6, M. Olandoski7, F. Teixeira8, R. Silva1, M. Sacchi9, A. Yamada4, R. Saad-Hossne10, A. Spinelli9,11, 1Cajuru University Hospital - Catholic University of Parana, Colorectal Surgery Unit, Curitiba, Brazil, 2Yokkaichi Social Insurance Hospital, IBD Unit, Yokkaichi, Japan, 3Humanitas Research Hospital, IBD Unit - Gastroenterology, Milano, Italy, 4Toho University - Sakura Medical Center, Internal Medicine, Chiba, Japan, 5Heliopolis Hospital, IBD unit, São Paulo, Brazil, 6Cajuru University Hospital - Catholic University of Parana, Gastroenterology, Curitiba, Brazil, 7Catholic University of Paraná, Statistics, Curitiba, Brazil, 8Gastrosaude, Colorectal Surgery, Marilia, Brazil, 9Humanitas Research Hospital, Medical Biotechnologies and Translational Medicine, Milano, Italy, 10São Paulo State University, Digestive Surgery Department, Botucatu, Brazil, 11Humanitas Research Hospital, IBD Surgery Unit, Milano, Italy

Background

Early postoperative endoscopic recurrence (EPER) occurs in a significant percentage of Crohn's disease (CD) patients one year after ileocecal resection. Several aspects influence the EPER rates, mainly medical therapy after surgery and patient characteristics. There is lack of comparative data between different regions of the world in terms of EPER in CD patients. The aim of this study was to compare the rates of EPER between patients treated in 3 different countries.

Methods

The MULTIPER (Multicenter International Postoperative Endoscopic Recurrence) database was a retrospective analysis of EPER rates in CD patients after ileocecal resection, from 7 referral centres from 3 different countries. All consecutive patients submitted to ileocecal resections that had colonoscopies performed up to 12 months after surgery were included. Recurrence was defined as Rutgeerts' score equal or greater than i2. The patients were allocated in 3 groups, regarding the country of the referral centre: Brazil, Japan or Italy. The EPER rates were compared between the 3 groups. Statystical analysis was performed by Fischer and chi-square tests (qualitative variables), and by Student's t test and Mann–Whitney test (quantitavive variables). ANOVA and Kruskal–Wallis methods were used in the comparison between the 3 groups. Multivariate analysis with adjusted logistic regression for recurrence was performed, with relevant clinical variables, with p < 0.05 considered significant.

Results

231 consecutive patients were initially analyzed (63 excluded for missing data and for having the first colonoscopy after surgery longer than 12 months) and 168 were included in the database (72 treated in Brazil, 53 in japan and 43 in italy). The groups were homogeneous except for CD duration (p = 0.002), previous resections (p < 0.001) and perianal CD (p = 0.004). EPER occurred in 31.94% in Brazil (B), 37.74% in Japan (J) and 13.95% in Italy (I). In direct comparison: B vs. I: p = 0.036 (OR: 2.89; 95% CI: 1.06–7.89); J vs. I: p = 0.012 (OR: 3.74; 95% CI: 1.33–10.51) and J vs. B: p = 0.501 (OR: 1.29; 95% CI: 0.61–2.73). On multivariate analysis, using patients treated in Italy as reference, both patients treated in Brazil and Japan had higher risk for recurrence (OR = 2.37 and OR = 2.31, respectively).

Conclusion

In the MULTIPER database, patients treated in Italy had significantly lower rates of EPER when compared to the ones treated in Brazil and Japan. This can be explained by lower CD duration in the italian group, among other baseline characteristics. Multicentric international prospective data collection on EPER rates could highlight eventual roles of other features as genetic influence, diet and other environmental factors, in postoperative prevention of recurrence.