P131 Predicting early endoscopic recurrence after ileocolic resection for Crohn’s disease
S. Monteiro*1, T. Cúrdia Gonçalves1, P. Boal Carvalho1, M. J. Moreira1, J. Cotter1, 2, 3
1Hospital da Senhora da Oliveira-Guimarães, Gastroenterology, Guimarães, Portugal, 2Institute for Research in the Life and Health Sciences, University of Minho, Braga, Portugal, 3Associate Laboratory ICVS / 3B’s, Braga/Guimarães, Portugal
Up to 80% of patients with Crohn’s disease (CD) undergo abdominal surgery during their lifetime, and up to 90% of patients have endoscopic recurrence within 12 months of surgery. Therefore, it becomes very important to identify predictors of early endoscopic recurrence, guiding the decision of postoperative strategy. The aim of this study was to determine the rate of early endoscopic recurrence after ileocolic resection for CD and identify possible predictors.
We conducted a retrospective single-centre study including patients with CD who underwent an ileocolic resection between 2003 and 2014. Early recurrence was defined according to the Rutgeerts’ score, defined as i2, i3, or i4 at ileocolonoscopy performed 6 to 12 months after surgery. A multivariate logistic regression was performed including significant variables on univariable analysis to identify predictors of early recurrence.
The following variables were evaluated: gender, age at diagnosis, age at surgery, preoperative disease duration, Montreal classification, smoking status, preoperative medication, erythrocyte sedimentation rate and C-reactive protein before the surgery, timing of surgery (elective or urgent), type of anastomosis (end-to-end, end-to-side, side-to-end, or side-to-side), surgical procedure (open or laparoscopic), extension of bowel resected, presence of granulomas in surgical specimen, and prophylactic immunosuppressive or anti-TNF therapy.
From the 42 included patients, 50% were female and had a mean age of 29.2 years at diagnosis. The most common indications for ileocolic resection were strictures (33.3%) and abscess (23.8%). The mean period of the first postoperative colonoscopy was 9 months, and recurrence was observed in 25 patients (59.5%). The perianal disease and shorter duration of CD were the only predictors of early recurrence, (p = 0.024; OR 8.36, 95% CI 1.329–52.642) and (p = 0.039; OR 0.965, 95% CI 0.933–0.998), respectively.
Early recurrence affects almost two thirds of CD patients after ileocolic resection, with perianal involvement and a shorter duration of disease being significant risks factors of early recurrence. These factors may indicate a more aggressive disease associated with rapid progression, and support the need of intensive early treatment to improve patients’ outcomes.