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P553 Clinical and surgical recurrences in Crohn’s disease: a 15-year follow-up cohort study from a tertiary centre in Northern Italy

L. Campanati*1, G.-E. Nita1, A. Indriolo2, F. Rubertà, E. Poiasina1, P. Ravelli2, L. Ansaloni1

1Papa Giovanni XXIII Hospital, I General Surgery Unit, Bergamo, Italy, 2Papa Giovanni XXIII Hospital, Gastroenterology and Digestive Endoscopy Unit, Bergamo, Italy

Background

Between 2000 and 2015, an interdisciplinary team of gastroenterologists and surgeons were joined together for the clinical management of patients (pts) with inflammatory bowel disease from a tertiary centre in Northern Italy. The aim of the study was evaluate the incidence of intestinal resection and perianal procedure during 15 years follow-up and its clinical and intestinal resection recurrence amongst CD pts.

Methods

During this period, we attended 204 patients with CD. From the IBD database, the following parameters were considered: year of onset, localisation gastro-enteric (GE) tract, year, and the type of surgery, clinical and surgical recurrence at 1, 5, 10, and 15 years of follow-up. Results were processed in a univariate analysis. The presence of clinical recurrence means CDAI >150.

Results

In the study, 50.5% were male; with the median onset age 34 years, (6–86), and a median follow-up period of 8 years (1–56). Further, 19.6% were lost at follow-up; 3.43% died; and 2.4% for colo-rectal cancer. Further, 94% reached 1-year of follow-up; 80% 5 years; 53% 10 years; and 34% 15 years, respectively. The primarily involved GE tract was ileo-colonic, 49% as last ileal loop and caecal colonic tract (L1), in 24.5% there was only an ileal involvement (L1); 21% had a colo-rectal involvement (L2); and in 1% the gastro-duodenal tract was afflicted (L4). In addition, 3% had a perineal involvement. Moreover, 53.4% underwent surgery: 45% underwent abdominal intervention for intestinal resection; 7% underwent a perineal procedure; 1% were treated with perineal and derivative combined procedure; and 30% underwent emergency surgery for CD complications, of whom 24% underwent abdominal procedures, and in 1%, the combined procedure was necessary. The incidence of intestinal resection and perineal procedure were 24%/5% at the onset; 29%/12% at 1 year; 47%/9% at 5 years; 51%/8% at 10 years; 63%; and 8% at 15 years, respectively, (Figure 1). The incidence of clinical and intestinal resection recurrence were 61%/0% at 1 year; 48%/5% at 5 years; 27%/4% at 10 years; 34%/7% at 15 years, respectively.(Figure 2).

Figure 1.

Figure 2.

Conclusion

In many cases, the surgical treatment is still performed at the clinical onset, because of complications. The clinical recurrence is increased at 5 years of follow-up, and diminished thereafter. The incidence of perineal procedure is constant in the follow-up, whereas intestinal resection increases during follow-up.