P601 Postoperative Crohn's Disease, Recurrence Rate and Risk Factors
S.L. Jaspers1, M. Duijvestein*1, A.E. van der Meulen - de Jong2, G.R. D'Haens1
1Academic Medical Center (AMC), Gastroenterology and Hepatology, Amsterdam, Netherlands, 2Leiden University Medical Center (LUMC), Gastroenterology and Hepatology, Leiden, Netherlands
Surgery for Crohn's disease (CD) is not a cure and postoperative recurrence is common. There are numerous studies that report numbers of postoperative recurrence after ileocecal resection, but with varying results. Endoscopy is the gold standard and endoscopic recurrence predicts clinical relapse. We retrospectively determined the postoperative endoscopic recurrence rate as well as risk factors for endoscopic recurrence.
Patients with CD who underwent an ileocecal resection between 2008 and 2013 in two referral centers in the Netherlands were included. Patients who did not undergo an ileocolonoscopy within two years postoperatively were excluded. The modified Rutgeerts score was the primary outcome to determine endoscopic recurrence (modified Rutgeerts score>i2a, i2a: lesions confined to the ileocolonic anastomosis). Secondary outcome was to identify risk factors like Montreal classification, smoking behaviour, previous resection(s), gender, family history of inflammatory bowel disease (IBD), surgery indication, type of anastomosis, ileum length resected and postoperative use of medication.
The overall endoscopic recurrence rate was 38.1% in the 105 included patients. The recurrence rate in patients who used postoperative biologics was 26.3%, 23.8% in patients who used immunomodulators and 51.9% in patients without postoperative medication. Only smoking the year before surgery (OR; 3.590, 95% CI 1.269-10.233, p=0.017) seemed to be a significant risk factor in the multivariate analysis for risk factors for endoscopic recurrence. Postoperative use of medication was a protective factor (not significant, but a trend OR; 0.381, 95% CI 0.142-1.018, p=0.054), which reduced the risk with 61.9%.
This retrospective multicenter cohort study is the first study that used the modified Rutgeerts score to evaluate endoscopic recurrence. The endoscopic recurrence rate found was lower than in previous studies. Based on this study, special attention should be paid in the preoperative phase to patients with smoking habits. Postoperatively, an early start with immunomodulators or anti-tumor necrosis factor (TNF) therapy should be taken into consideration.