For adults with Crohn's disease, how does colonoscopic surveillance compare with clinical recurrence for guiding the intensification of prophylactic therapy after intestinal resection?

Abstract Background 70% of patients with Crohn’s disease (CD) require intestinal resection.1 Post-operative recurrence (POR) is common with 70% of patients requiring further surgery in the pre-biologic era.2 ECCO guidelines suggest identifying patients at risk of recurrence (disease phenotype, smoking, prior resection), the use of imidazole antibiotics following surgery and assessment for recurrence within 12 months. The ECCO guidelines recommend ileocolonoscopy, although alternative modalities can be used. The Rutgeerts score predicts POR and is recommended to establish the need for preventative treatment.3 The aim of this study was to undertake a region-wide audit of practice with regards to post-operative CD in the Northern region. Methods A regional, multicentre, retrospective audit was conducted by GRANT, a network of gastroenterology trainees in Northern England. Data collection was performed for CD patients who had an ileocaecal resection between 1/9/16 and 1/9/17. Patients with an end-ileostomy were excluded. Patients were identified using clinical coding and data collection sheets were completed. Results Seven of 9 Hospital Trusts returned data. The number of eligible patients was 38 with a mean age of 41 years. Seventy-six per cent (29/38) patients had at least one risk factor rendering them ‘high-risk’ for POR (Figure 1). Only 13% (5/38) of patients received imidazole antibiotics postoperatively and only 29% (11/38) had an ileocolonoscopy within 12 months. However, 32% (12/38) had an alternative assessment of POR, with calprotectin being the most popular. An escalation in treatment following assessment was required in 25% (9/38) of patients. Postoperatively, 40% (15/38) of patients had no maintenance therapy before POR assessment; 26% (10/38) continued on the same therapy as preoperatively and34% (13/38) had augmented pre-operative therapy. Conclusion The majority of patients in Northern England who have an ileocaecal resection for CD are high risk for recurrence and many patients are not being assessed. Endoscopic POR predates clinical POR [4] and, without monitoring, the opportunity to augment therapy and prevent clinical recurrence can be missed. In Northern England, less invasive disease monitoring is being used to assess for POR and this audit would suggest that these have a comparable rate of identifying a need to escalate maintenance therapy. A postoperative CD management bundle is being developed and will be implemented to assess whether this drives improvement.

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P229 The modified postoperative endoscopic recurrence score for Crohn's disease: Does it really make a difference in predicting clinical recurrence?

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjx002.354 ◽

2017 ◽

Vol 11 (suppl_1) ◽

pp. S194-S194

Author(s):

P. Rivière ◽

S. Vermeire ◽

G. Van Assche ◽

P. Rutgeerts ◽

A. De Buck van Overstraeten ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Recurrence Score ◽

Clinical Recurrence ◽

Endoscopic Recurrence

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Sa1301 Patterns of Clinical Recurrence and Health Care Utilization in Post-Operative Crohn's Disease: Two Year Outcomes

Gastroenterology ◽

10.1016/s0016-5085(12)61008-7 ◽

2012 ◽

Vol 142 (5) ◽

pp. S-267 ◽

Cited By ~ 1

Author(s):

Mahesh Gajendran ◽

Andrew R. Watson ◽

Wolfgang H. Schraut ◽

Miguel Regueiro ◽

Eva Szigethy ◽

...

Keyword(s):

Health Care ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Health Care Utilization ◽

Care Utilization ◽

Clinical Recurrence

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Appendiceal Carcinoids In Crohn’s Disease

Canadian Journal of Gastroenterology ◽

10.1155/2003/625368 ◽

2003 ◽

Vol 17 (1) ◽

pp. 43-46 ◽

Cited By ~ 17

Author(s):

Hugh J Freeman

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Carcinoid Tumour ◽

Intestinal Resection ◽

Case Review ◽

Appendiceal Neoplasms ◽

Increased Risk ◽

Intestinal Neoplasms ◽

Resection Specimen ◽

Sporadic Cases

Earlier investigations demonstrate an increased risk for colon cancer in Crohn's disease. For other intestinal neoplasms, such as carcinoids, studies are limited. In Crohn's disease, repeated endoscopic and imaging studies along with intestinal resections may facilitate clinical recognition of neoplastic diseases, including appendiceal neoplasms. To date, however, only sporadic cases of appendiceal carcinoids have been described in Crohn's disease. In the present study, in a single clinician database of 1000 Crohn's disease patients, three of the 441 patients who had undergone intestinal resection had appendiceal carcinoids, all of which were pathologically confirmed. All were observed in female patients and were not suspected before surgical treatment. In one case, even though management was not altered, the tumour had already invaded serosal fat indicating a potential for more advanced disease. In this series, a carcinoid tumour was found in a resection specimen during a later clinical case review and another was a microcarcinoid, implying that these tumours may be overlooked in Crohn's disease. The percentage detected in the entire database (0.3%) exceeds the reported rates of detection of appendiceal carcinoids after removal of the appendix for appendicitis, as well as the rate of detection of appendiceal carcinoids in autopsy studies. This percentage would be higher if only those having an intestinal resection were considered (0.68%). Additional studies are needed to further define this risk of appendiceal carcinoids in Crohn's disease.

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