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* = Presenting author

P376 Therapy refractory ulcerative colitis patients may benefit from appendectomy: early result from the PASSION study

S. Sahami*1, C. Buskens1, D. Winter2, S. Martin2, P. Tanis1, G. van den Brink3, M. Löwenberg3, G. Cullen4, H. Mulcahy4, G. Doherty4, C. Ponsioen3, G. D’Haens3, W. Bemelman1

1Academic Medical Centre, Surgery, Amsterdam, Netherlands, 2St. Vincent’s University Hospital, Surgery, Dublin, Ireland, 3Academic Medical Centre, Gastroenterology & Hepatology, Amsterdam, Netherlands, 4St. Vincent’s University Hospital, Gastroenterology & Hepatology, Dublin, Ireland

Background

Evidence has been accumulating indicating that the appendix has an immunomodulatory role in patients with UC, potentially reducing the need for medication and colectomy. However, prospective data are limited, and the therapeutic mechanism is not yet understood. The objective of this study was to examine the effect of an appendectomy to modulate the disease course of therapy refractory UC patients.

Methods

Patients with therapy refractory UC, and referred for proctocolectomy were invited to undergo laparoscopic appendectomy first. The primary endpoint was clinical response at 3 months and after 12 months. Secondary endpoints were remission, improvement in IBDQ score, and failure. Results were measured by the Mayo score (partial clinical 0–9 and endoscopic 0–3) and IBDQ score (32 to 224). Clinical response was defined as a decrease in the partial Mayo of ≥ 3 points. Remission was defined as an endoscopic Mayo ≤1 point. Improvement in IBDQ was defined as an increase of >20 points. Failure was defined as when patients underwent colectomy or prescribed trial medication (eg, vedolizumab and etrolizumab).

Results

In total, 30 patients (57% female) with a median age of 40 (IQR, 33–47) underwent appendectomy with a mean preoperative total Mayo score of 9 (SD 2). The mean baseline IBDQ was 125 (SD 34). After 3 months, clinical response was seen in 16 (53%) patients, of whom, 7 (30%) were in remission (7 patients refused endoscopy at this time point). Improvement in IBDQ was seen in 14 (47%) patients with a mean of 120 (SD 29) that increased to 168 (SD 29). After 12 months, 11 patients failed (7 colectomy and 4 trial medication), and 5 did not yet reach the endpoint. In the remaining 14 patients, 9 (36%) had lasting clinical response, of whom, 5 (23%) were in remission (3 patients refused endoscopy).

Conclusion

Appendectomy was effective in at least 30% of therapy refractory UC patients. These early results suggests that UC patients may benefit from appendectomy and that this effect is maintained for a longer period of time. However, follow-up of at least 2 years is warranted to exclude a possible placebo effect.