P694 Long-term monitoring of post-surgical recurrence in Crohn's disease using a strategy based on the periodic determination of fecal calprotectin in patients without early postoperative recurrence
Mañosa CiriaPhD, M.(1,2)*;Oller, B.(1);Garcia-Planella, E.(3);Guardiola, J.(4);Cañete, F.(1,2);Gonzalez Muñoza, C.(3);Camps, B.(4);Calafat, M.(1,2);Domènech, E.(2,5);
(1)Hospital Universitari Germans Trias I Pujol, Gastroenterology, Badalona, Spain;(2)Ciberehd, Ciberehd, Madrid, Spain;(3)Hospital de la Santa Creu i Sant Pau, Gastroenterology, Barcelona, Spain;(4)Hospital de Bellvitge, Gastroenterology, L'Hospitalet de LLobregat, Spain;(5)Hospital Universitari Germain Trias i Pujol, Gastroenterology, Badalona, Spain;
Background
Current guidelines recommend to perform an ileocolonoscopy 6-12 months after surgery in patients with Crohn's disease (CD) and ileo-cecal resection with ileocolic anastomosis to assess the occurrence of endoscopic post-operative recurrence (PORe) and escalate therapy if necessary. However, it is not established whether and/or when endoscopic monitoring is advised in patients who do not present early PORe
OBJECTIVE: To evaluate the usefulness of a strategy based on the periodic determination of faecal calprotectin (FC) to decide whether to carry out a new endoscopic control in patients without PORe (iR<2) in the last endoscopic assessment performed
Methods
Pilot, prospective, multicentre and open study. Inclusion criteria: 1) CD with intestinal resection and ileo-colic anastomosis; 2) last ileocolonoscopy after surgery with a Rutgeerts score i0 or i1; 3) No suspicion of clinical POR. Patients with an ostomy or chronic use of NSAIDs or omeprazole were excluded. Centralized FC determinations were performed every 4 months for 2 years and an ileocolonoscopy at the end of follow-up was performed. In the case of FC>250μg/g in 2 consecutive determinations, ileocolonoscopy was advanced and the patient was withdrawn from the study. The main variable of interest was the rate of advanced PORe (as defined by Rutgeerts score >i2) at the final ileocolonoscopy.
Results
55 patients were included, 13% perianal disease, 24% smokers and 27% surgery prior to the index surgery. 47% followed prevention with thiopurines and 14% with anti-TNF. During follow-up, 7 patients had FC>250μg/g in two consecutive determinations; advanced PORe was identified in 5 of these patients, PORe i2 in one and intestinal adenocarcinoma in another one. Among the patients who completed the 2-year follow-up, none had advanced PORe at the final ileocolonoscopy although intermediate PORe (i2) was found in 12. The rate of advanced PORe was 71% in those who finished the study before 2 years and 0% in those who were not advanced to endoscopy. The AUC for FC to detect advanced PORe was 0.98 (p=0.002). The cut-off point of FC>250μg/g obtained a sensitivity of 100% and specificity of 60% to detect advanced PORe.
Conclusion
The serial determination of FC is a suitable long-term monitoring tool to decide whether to perform ileocolonoscopy in patients without early PORe.