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P274 The clinical significance of anastomotic ulcers after ileocolic resection to predict postoperative recurrence of Crohn’s disease

J.Y. Kim1, S.H. Park1, Y.J. Kim2, J.C. Park1, S. Noh1, J.S. Lee1, J. Kim1, N.S. Ham1, E.H. Oh1, S.W. Hwang1, D.H. Yang1, B.D. Ye1, J.S. Byeon1, S.J. Myung1, S.K. Yang1

1Asan Medical Center, Gastroenterology, Seoul, Korea Republic of, 2Asan Medical Center, Clinical Epidemiology and Biostatistics, Seoul, Korea Republic of

Background

The Rutgeerts score (RS) is used to predict postoperative recurrence in Crohn’s disease (CD) patients after ileocolic resection primarily based on endoscopic finding at the neoterminal ileum. However, assessing anastomotic ulcers (AUs) is still a matter of debate. Our aim was to investigate the clinical significance of AUs on endoscopic recurrence in postoperative CD patients.

Methods

This was a single-centre retrospective study analysing postoperative CD patients with the RS of i0 to i1 at the first ileocolonoscopy within 1 year after ileocolic resection between 2000 and 2016 and those who underwent subsequent ileocolonoscopic follow-up. The study outcome was the clinical significance of AUs predicting endoscopic recurrence (RS ≥ i2b).

Results

Among 116 patients who were in endoscopic remission at the index postoperative ileocolonoscopy, 84.5% (98/116) underwent subsequent ileocolonoscopies. During the 30.0 months (interquartile ranges, 21.3–53.3) of median follow-up periods after the index ileocolonoscopy, 56.1% (55/98) showed endoscopic recurrence. Furthermore, 65.8% (48/73) with AUs and 75.5% (40/53) with major AUs defined as ulcer occupying ≥ 1/4 of the circumference or ≥ 3 ulcers confined to anastomotic ring, or any ulcers extended to ileocolic mucosa showed endoscopic recurrence. On multivariable analysis, the presence of AUs (adjusted hazard ratio [aHR], 4.33; 95% confidence interval [CI], 1.87–10.0; p < 0.001) and major AUs (aHR, 3.64; 95% CI, 1.95–6.79; p < 0.001) were associated with endoscopic recurrence, respectively.

Conclusion

AUs are associated with a significantly higher risk of endoscopic recurrence in postoperative CD patient who are in endoscopic remission.