P442 Strictureplasty for Crohn’s disease of the small bowel in the biological era: long-term outcomes and risk factors for site specific recurrence
M. Rottoli*1, C. A. Manzo1, M. Tanzanu1, F. Rizzello1, P. Gionchetti1, G. Poggioli1
1Sant'Orsola Hospital, Alma Mater Studiorum University of Bologna, Department of Medical and Surgical Sciences, Bologna, Italy
Patients affected by Crohn’s disease (CD) often require multiple surgeries and are at higher risk of short bowel syndrome. While bowel-sparing techniques should still have an indication in these patients, a considerable reduction of the use of strictureplasty has been observed, especially since the introduction of biological drugs.
Patients undergoing strictureplasty for small bowel CD from 2002 were included.
Risk factor for recurrence of CD were analysed through a multilevel logistic regression analysis, considering the hierarchical structure of the data. Level-2 variables were related to patient, level-1 to strictureplasty. A model without predictors was run to calculate the intraclass correlation coefficient to evaluate the degree of homogeneity of the outcome within patients; an intermediate model adding level-1 and level-2 variables and testing all intra-level interactions was subsequently performed. The estimated residual standard deviation and the estimated residual intraclass correlation of random-intercept logistic model were calculated. All
A total of 266 patients were included in the study. Overall, 718 strictureplasties were performed. Median follow-up time was 96 months (6–209). Site specific recurrence rate was 1.6% at 2 years, 12.7% at 5 years, and 25.7% at 10 years.
|Number, mean or median||%, standard deviation or range|
|Total number of patients||266|
|Mean number of strictureplasties/patient||1.95||±2.85|
|Median age of patients (years)||39.5||18–76|
|Median years of disease||8.2||0.1–37|
|Number of additional resections||196||73.7%|
|Smoking after strictureplasty||68||25.6%|
|Biologics after strictureplasty||79||29.7%|
|Biologics before strictureplasty||72||27.1%|
|Previous surgery for Crohn’s disease||85||32.0%|
Characteristics of patients undergoing strictureplasty for Crohn's disease
|Total number of strictureplasty||718|
|Recurrence on strictureplasty||36||5|
|Recurrence on anastomosis||31||4.3|
Characteristics of the strictureplasties performed
|Variables||Odd ratio||Standard error||p-value|
|Strictureplasty on previous anastomosis||13.59||11.18||0.002|
|Total number of strictureplasties||1.13||0.08||0.088|
|Use of biologics after strictureplasty||4.75||2.25||0.001|
|Duration of disease||1.26||1.04||0.776|
Results of the multi-level regression logistic analysis of risk factors for site specific recurrence.
Strictureplasty is a safe procedure and is correlated with acceptable recurrence-free rates also after a very long follow-up time. Despite nonconventional strictureplasties are associated with a significantly higher risk of site specific relapse, whenever possible a bowel sparing technique should be performed, especially in the presence of long strictures. In case of a recurrence of a previous anastomosis, a resection should be preferred. The use of biologics after surgery identifies patients at higher risk of recurrence. The effect of biological drugs on long-term outcome after bowel sparing technique should be assessed in future prospective trials.