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P345 Risk of long-term post-operative recurrence (POR) in Crohn’s disease patients with a first postoperative normal endoscopic assessment under thiopurine prevention

M. Mañosa1,2, M. Puig1, P. F. Torres1, F. Cañete1, J. Troya3, M. Calafat1, D. Parés3, E. Cabré1,2, E. Domènech1,2

1Hospital Universitari Germans Trias i Pujol, Gastroenterology, Badalona, Spain, 2Ciberehd, Madrid, Spain, 3Hospital Universitari Germans Trias i Pujol, Surgery, Badalona, Spain

Background

Endoscopic post-operative recurrence (PORe) in Crohn's disease (CD) occurs between 30 and 50% after intestinal resection with anastomosis under preventive treatment within the first 6–12 months after surgery. The natural history of those patients who do not present PORe in the first endoscopy is not known and no recommendations about PORe monitoring beyond the first year after surgery in this population are available. Objective: To evaluate the natural history of the PORe in those patients who do not present PORe in the first endoscopic assessment.

Methods

From a specific database including all patients with CD who underwent resection with anastomosis at our institution since 1998 were prospectively included and followed, we identified those who initiated AZA within the first month after surgery and who underwent a first endoscopic assessment showing no PORe (Rutgeerts score i1) and who had at least a further endoscopic assessment. PORe was defined by Rutgeerts score i2, clinical POR (PORc) as the appearance of symptoms requiring changes in CD treatment, and surgical recurrence (PORs) as the need for a new resection. We defined a combined outcome (CO) as the occurrence of any of the following events: need for biological agents, PORc, or PORs during the follow-up.

Results

From 291 patients undergoing ileocolic resection and anastomosis, 94 patients (29%) had a first post-surgery endoscopy with Rutgeerts score i1. Regarding PORe risk factors: 52% penetrating pattern, 48% smokers at surgery, 12% previous resections and 22% perianal disease. Twenty-one per cent of patients received metronidazole in the first 3 months postop. The median follow-up was 84 (IQR 49–156) months. Thirty-seven per cent developed PORe (median 45 [IQR 30–60] months), of whom 65% were i2 and 35% were i3-i4, whereas only 14% PORc and 3.6% PORs. The accumulated probability of developing PORe during the follow-up was 0%, 16%, 40% and 50% at 1, 3, 5, and 10 years from the first postop endoscopic assessment, while the cumulative probability of CO was 1%, 2.5% 12%, and 19% at 1, 3, 5, and 10 years. No factors were associated with PORe.

Conclusion

The risk of PORe in patients without significant lesions in a first endoscopic assessment under thiopurine prevention is relatively low but steady over time, suggesting that monitoring remains necessary. In these patients PORs is very low in the long-term.