P476 EArly SurgerY or Immunosuppression - EASY study
F. Magro*1, R. Coelho1, S. Fernandes2, A. Rodrigues3, A. Oliveira4, P. Sousa5, R. Barosa6, P. Boal Carvalho7, D. Trabulo8, M. Eusébio9, J. Moleiro10, R. Herculano11, P. Peixe11, B. Gonçalves12, H. Morna13, H. Tavares14, L. Contente14, R. Gonçalves12, P. Caldeira9, I. Rosa10, I. Cremers8, J. Cotter7, A. Vieira6, P. Ministro5, F. Portela4, C. Caetano3, P. Moura-Santos2, S. Lopes1, C. Camila-Dias15
1Centro Hospitalar São João, Gastrenterology, Porto, Portugal, 2Hospital de Santa Maria , Gastrenterology, Lisboa, Portugal, 3Centro Hospitalar do Porto, Gastrenterology, Porto, Portugal, 4Centro Hospitalar e Universitário de Coimbra, Gastrenterology, Coimbra, Portugal, 5Centro Hospitalar Tondela- Viseu, Gastrenterology, Viseu, Portugal, 6Hospital Garcia de Orta, Gastrenterology, Almada, Portugal, 7Centro Hospitalar do Alto Ave, Gastrenterology, Guimarães, Portugal, 8Centro Hospitalar de Setúbal, Gastrenterology, Setúbal, Portugal, 9Hospital de Faro , Gastrenterology, Faro, Portugal, 10Instituto Português de Oncologia de Lisboa, Gastrenterology, Lisboa, Portugal, 11Centro Hospitalar de Lisboa Ocidental, Gastrenterology, Lisboa, Portugal, 12Hospital de Braga, Gastrenterology, Braga, Portugal, 13Hospital Dr. Nélio Mendonça, Gastrenterology, Funchal, Portugal, 14Centro Hospitalar do Barlavento Algarvio, Gastrenterology, Portimão, Portugal, 15University of Porto, CIDES-Department of Health Information and Decision Sciences, Faculty of Medicine, Porto, Portugal
Crohn's disease (CD) can be treated medically or surgically. Surgery was considered the last option. Immunomodulators have shown efficacy in maintaining remission and surgery by using bowel sparing techniques and laparoscopic approach improved earlier recovery and morbidity. Studies addressing the timing of surgery or medical treatment are scarce. Aims: Our aim was to compare the outcome in CD patients submitted to immunomodulators or surgery in the first six months after diagnosis.
It is a national, multicentric study on CD patients diagnosed and followed for more than three years and submitted to immunomodulators (index episode) or surgery (index episode) in the first six months after diagnosis. Disability was defined as: one surgery or hospitalization in the first five years after the index episode or more than one surgery or two hospitalizations in the follow-up, more than two courses of corticosteroids per year, corticosteroid dependency, or resistance, needed of switch of the first immunomodulator or anti-TNF, or appearance of clinical events after index episode (fistula, abscess, stenosis, perforation or anal disease).
With a follow-up of 12.6 years (IQ:7.9;41.4) 615 patients were analysed. It was possible to identify four cohorts with different outcome: A-patients submitted to surgery in the first 6 months after diagnosis without any immunosuppression thereafter, B- patients submitted to surgery in the first 6 months after diagnosis and under immunosuppression within the first two months after surgery, C-patients submitted to surgery in the first 6 months after diagnosis and in immunosuppression only after the second month after surgery, and D- those under immunosuppression in the first 6 months after diagnosis and without any surgery in this period. In the table are shown the main outcomes.
Patients older than 40 years and with ileal disease the surgery was the best option with regards disability, however early introduction of immunomodulators showed to be the best strategy in bowel sparing.