P127 Clinical outcomes of ileocaecal Crohn's disease: Surgery versus pharmacotherapy
Y. Park*, S.P. Hong, S.J. Park, T.I. Kim, W.H. Kim, J.H. Cheon
Yonsei University College of Medicine, Department of Internal Medicine and Institute of Gastroenterology, Seoul, South Korea
Ileocaecal Crohn's disease (CD) with disease activity confined to the terminal ileum, with or without caecal involvement, can be treated either surgically or medically. However, little is known about the timing of surgery or benefits of surgery compared to medical treatment. The aims of this study were to assess outcomes after medical versus surgical management of ileocaecal CD in the current era.
Of 885 patients with CD diagnosed and prospectively enrolled in our hospital between 1980 and 2013, 93 (10.5%) ileocaecal CD patients were identified. Those who had a follow-up shorter than 6 months were excluded (n = 5). Patients were assigned to either medical or surgical remission group by initial management strategy that had leaded to remission. Relapse, hospitalization, and surgery rates after medically or surgically induced remission were compared using Kaplan-Meier curve with log-rank test.
Patients assigned to surgical and medical remission groups were 15 (17.0%) and 73 (83.0%), respectively. Median follow up duration was 6.6 years (interquartile range, 3.1 - 9.9 years). In total, relapse occurred in 48 (54.5%) patients, and the median time to relapse was 3.9 years (95% confidence interval, 3.1 - 4.7 years). Surgical remission group showed a lower relapse rate with prolonged maintenance of remission (10.7 vs. 3.7 years; P = 0.017). Hospitalization after first remission tended to be lower in surgical remission group (P = 0.054), and there was no case with repeated intestinal resection after initial surgical remission strategy, whereas 23% and 39% of surgery rates were reported at 5 and 10 years after initial medical treatment (P = 0.037). At multivariate analysis, initial medical management strategy (Hazard ratio [HR] = 3.23, P = 0.039) were strongly associated with relapse in ileocaecal CD, along with a younger age at diagnosis (HR = 1.06, P = 0.003) and a longer time to achieve first remission (HR = 1.04, P = 0.013).
Overall outcomes of ileocaecal CD are excellent with 44.5% of patients remaining symptom-free at 5 years after first remission. In selected cases of localised ileocaecal CD, ileocolic resection might be a good alternative to the long-term medical treatment, with a lower relapse rate and prolonged maintenance of remission.