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P115 Monitoring faecal calprotectin at 3 months post-surgery is useful to predict further postoperative endoscopic recurrence in Crohn's disease

F. Veyre1, S. Nancey1, C. Meunier1, X. Roblin2, C. Cuerq3, A. Mialon3, P. Danion1, M. Chauvenet1, B. Flourie1, G. Boschetti*1

1Hospices Civils de Lyon, Gastroenterology, Pierre Benite, France, 2CHU Saint Etienne, Gastroenterology, Saint Etienne, France, 3Hospices Civils de Lyon, Biochemistry, Pierre Benite, France

Background

Most of the patients with Crohn's diseases (CD) underwent surgery and the risk of postoperative recurrence remains high. An ileocolonoscopy is recommended within the first year post-surgery to detect postoperative endoscopic recurrence (POR) that precedes clinical recurrence. Faecal Calprotectin (fCal) monitoring within the first year post-surgery is useful to predict POR and could avoid performing some colonoscopies. However, the usefulness of an early postoperative monitoring of fCal as soon as 3 months post-surgery to detect the occurrence of further POR within 1 year after surgery remains unknown.

Methods

Stool samples were collected 3 months post-surgery in a cohort of 55 consecutive CD patients who had undergone an ileocolonic resection to measure fCal concentrations by an immunoenzymatic assay (Bühlmann). An ileocolonoscopy was performed within the first year post-surgery and endoscopic recurrence, graded by the Rutgeerts score (POR defined as Rutgeerts >i1) was assessed. The performance, sensitivity, specificity, predictive values of fCal levels to predict further POR as well as the optimal cut-off point capable to predict POR has been determined by ROC curves.

Results

At 3 months post-surgery, the mean fCal levels were significantly higher in patients with endoscopic recurrence, when compared with those in endoscopic remission (204.9 µg/g; 95% CI [124–660 µg/g] vs. 102.9 µg/g [61–207 µg/g] respectively; p = 0.0071). Based on the AUROC, the accuracy of fCal measured at 3 months post-surgery was 0.712. The respective sensitivities, specificities, positive and negative predictive values according to various cut-off points are summarised in Table 1. The fCal value of 65 µg/g was the best cut-off point to accurately distinguish the patients who will further experience a POR from those who will stay in endoscopic remission, and this could allow avoiding around 20% of colonoscopies given the high NPV of fCal in this setting.

fCal (g/kg) cut-offSen (%)Spe (%)PPV (%)NPV (%)
5096194686
6596315091
7587344979
10578535577

Conclusion

The present study reports the usefulness of monitoring fCal as soon as 3 months post-surgery to predict accurately POR in CD patients. FCal levels below 65 µg/g at 3 months post-surgery could help making decision to avoid performing an ileocolonoscopy within 1 year post-surgery.