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P537. Clinical factors of anastomotic recurrence revealed in patients with Crohn's disease at double-balloon enteroscopy

T. Yamamura1, M. Nakamura1, K. Yamada1, A. Nagura2, T. Yoshimura1, A. Nakano1, H. Oshima1, K. Hurukawa2, K. Funasaka2, E. Ohno2, R. Miyahara1, H. Kawashima1, A. Itoh1, Y. Hirooka2, O. Watanabe1, T. Ando1, N. Ohmiya3, H. Goto1,2, 1Nagoya University, Gastroentorology and Hepatology, Nagoya, Japan, 2Nagoya University Hospital, Endoscopy, Nagoya, Japan, 3Fujita Health University School of Medicine, Gastroentorology, Toyoake, Japan

Background

Small-bowel lesions in patients with Crohn's disease (CD) remain clinical challenge. Postoperative small-bowel anastomosis is prone to recurrence. Recently, double-balloon enteroscopy (DBE) has enabled precise diagnosis and interventional therapies, balloon dilation (BD), against benign strictures of CD including primary and anastomotic regions in the small bowel. BD is considered an alternative to surgery in CD patients, but it is sometimes difficult to perform BD for conditions of regions. Therefore, it is useful to know factors that associates with strictures of CD. In this study, we determine the clinical factors that associates with anastomotic recurrence in patients with CD.

Methods

Between 2003 and 2012, 48 consecutive patients with CD who underwent DBE were enrolled. These 48 patients had undergone small-bowel resection previously and anastomotic sites were evaluated by Rutgeerts' endoscopic scoring. Multiple logistic regression analysis was performed to assess the relation of Rutgeerts' scores to variables such as gender, operative procedure (resection or stricutureplasty), usage of corticosteroids, immunomodulators, anti-TNFalfa antibody, and elemental diet, postoperative period, and previous surgical history. Kaplan-Meyer survival analysis with log-rank test was performed to assess the patency of anastomotic sites between the anti-TNFalfa antibody-treated group and the non-anti-TNFalfa antibody-treated group.

Results

Rutgeerts' grade 4 was significantly associated with abdominal symptoms, when compared with Rutgeerts' grades 0–3 (P < 0.0001). Endoscopic recurrence designated as Rutgeerts' grades 2–4 was associated with non-use of 5-aminosalicylic acid (P = 0.021) and post-operative period (longer than 1.5 year, P = 0.013). Clinical recurrence designated as Rutgeerts' grades 4 was associated with non-use of 5-aminosalicylic acid (P =0.048), post-operative period (longer than 1.5 year, P = 0.0002) and use of immunomodulators (P = 0.039). The patency of the anastomotic sites in the anti-TNFalfa antibody-treated group was better than in the non-anti-TNFalfa antibody-treated group (P = 0.035).

Conclusion

Non-use of IFX or 5-aminosalicylic acid and postoperative period was associated with recurrence of small-bowel anastomotic sites in patients with CD.