P257 Data on Surgery in Paediatric IBD (pIBD) over a 4 year period using the ImproveCareNow (ICN) Collaboration data base
S. Sider*1, S. Chadokufa1, B. Huggett1, N. Shah1, M. Elawad1, F. Kiparissi1, 2
1Great Ormond Street Hospital, Paediatric Gastroenterology, London, United Kingdom, 2University College London Hospitals NHS Foundation Trust, Department of Gastroenterology, London, United Kingdom
Paediatric Inflammatory bowel disease (pIBD) is commonly severe. The natural history pIBD is varied and can result in surgery to control unremitting disease. Colectomy rates(CR) of up to 20% have been reported by other centres. Previous data on Ulcerative Colitis (UC) patients at our center was 3.6%. Our centre joined Improve Care Now (ICN) in 2010 where we could benchmark our clinical outcomes against 66 other pIBD centres.
All surgical procedures performed were captured from our ICN database over a 4 year period in 283 paediatric patients (167 male, range 0.4y -16y, median 9.7y). 54% had Crohn's disease, 23% ulcerative colitis and 23% indeterminate colitis/IBDU.
All patients received standard pIBD treatment, escalating to biologic treatment on relapse. This aggressive approach lead to 5 (1.7%) of 283 IBD patients requiring surgery.
P1 (15y) had intractable fistulating Crohn's disease (CD) requiring a laparoscopic total colectomy/terminal ileum resection, developing peristomal fistulae, requiring further revision.
P2 (13y) with Crohn's-like IBD had spontaneous perforation, needing defunctioning ileostomy.
P3 (11y) had intractable ulcerative colitis (UC, 1/66, 1.64%) requiring subtotal colectomy
P4 (14y) had IBD unclassified (IBDU) with CD-like features with transfusion dependence, requiring subtotal colectomy/ileostomy formation.
P5 (8y) had intractable right-sided/TI CD requiring right hemicolectomy/loop ileostomy formation. Due to on-going small bowel inflammation, stoma ulcerations and rectal prolapse, stem cell transplant treatment was given and reconstructive surgery at our centre was performed one year later achieving continuity and being off all immunosuppressive medication.
In our institution surgical interventions rates are only 1.85 % of patients identified within the ICN database having received early and aggressive immunomodulatory and immunosuppressive treatment.