OC.12.4 NATURAL COURSE OF CROHN'S DISEASE AFTER ILEOCOLONIC RESECTION: EARLY CROHN'S DISEASE ASSOCIATES WITH A MIXED TH CELL RESPONSE PREDOMINANT ACCUMULATION NOT RELATED WITH ENDOSCOPIC RECURRENCE

Background. Postoperative endoscopic recurrence (PER) is common in patients with Crohn’s disease (CD) after surgery. The impact of the American Gastroenterological Association (AGA) guideline adherence on PER in real life remains unclear. Methods. The postoperative management of CD patients undergoing ileocolonic resection with anastomosis from 2017 to 2018 was conducted based on the AGA guidelines. Colonoscopies were performed within one year after surgery. Clinical data and risk factors for endoscopic recurrence were analyzed focusing on postoperative pharmacological prophylaxis. Results. All patients were at a high risk of postoperative recurrence according to the AGA guidelines. PER occurred in 29 (28.7%) of these patients. The overall PER rate was 39.2% at one year. The PER rate in patients treated with nitroimidazole, thiopurines, infliximab, or a combination of thiopurines and infliximab for postoperative prophylaxis was 88.1%, 34.1%, 20.5%, and 0%, respectively. Cox regression showed that smoking at the time of surgery and AGA guideline adherence were independent factors associated with PER (HR: 3.75, 95% CI: 1.36-10.33, P=0.01; HR: 0.36, 95% CI: 0.15-0.86, P=0.02). In addition, further investigation revealed that educational background was the main factor related to patients’ nonadherence to AGA guidelines. Conclusions. The majority of CD patients who undergo surgery in clinical practice may be at a high risk of disease recurrence. Thiopurines and infliximab are effective in preventing endoscopic recurrence. Guideline nonadherence is associated with PER at one year, thus indicating that there is room for improvement in adherence to the AGA guidelines.

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P189. Serial monitoring of faecal calprotectin for the assessment of endoscopic recurrence in asymptomatic patients after ileocolonic resection for Crohn’s disease: a long-term prospective study

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjw019.308 ◽

2016 ◽

Vol 10 (suppl 1) ◽

pp. S186.2-S186

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Prospective Study ◽

Faecal Calprotectin ◽

Endoscopic Recurrence ◽

Asymptomatic Patients ◽

Ileocolonic Resection

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Frequency and Pattern of Endoscopic Recurrence in Crohn's Disease Patients With Ileocolonic Resection Using a LaparoscopicVersusLaparotomic Approach: A Prospective Longitudinal Study

The American Journal of Gastroenterology ◽

10.1111/j.1572-0241.2007.01612_14.x ◽

2008 ◽

Vol 103 (3) ◽

pp. 809-811 ◽

Cited By ~ 3

Keyword(s):

Crohn’S Disease ◽

Longitudinal Study ◽

Crohn's Disease ◽

Prospective Longitudinal Study ◽

Endoscopic Recurrence ◽

Ileocolonic Resection ◽

Prospective Longitudinal

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OP04 Long-term outcomes after ileocolonic resection in Crohn’s disease according to the severity of early endoscopic recurrence

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.003 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S004-S005

Author(s):

N Hammoudi ◽

C Auzolle ◽

M L Tran Minh ◽

G Boschetti ◽

M Bezault ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Clinical Relapse ◽

Recurrence Free Survival ◽

Long Term Outcomes ◽

Clinical Recurrence ◽

Free Survival ◽

Endoscopic Recurrence ◽

Ileocolonic Resection

Abstract Background Early ileocolonoscopy within the first year after surgery is the gold standard to evaluate post-operative recurrence after ileocolonic resection for Crohn’s disease (CD). The aim of the study was to evaluate the association between lesions at ileocolonoscopy 6 months after surgery and long-term outcomes. Methods The REMIND group conducted a prospective multicentre study. Patients operated for ileal or ileocolonic CD were included. An ileocolonoscopy was performed 6 months after surgery. An endoscopic classification separating anastomotic and ileal lesions was built (Ax for anastomotic lesions; Ix for neo-terminal ileum lesions evaluated according to the Rutggerts score). Clinical relapse was defined by CD-related symptoms confirmed by imaging, endoscopy or therapeutic intensification, CD-related complication or subsequent surgery. Results A total of 225 patients were included. Long-term data were available for 193 patients (86%). Median follow-up was 3.82 years (IQR:2.56–5.41) from surgery. Median clinical recurrence-free survival was 47.6 months. Clinical recurrence-free survival was significantly shorter in patients with ileal lesions at early post-operative endoscopy whatever their severity (I1 or I2I3I4) compared with patients without (I0) (median survivals: 68.5, 33.0 and 39.1 months, respectively, for I0, I1 and I2I3I4; I0 vs. I2I3I4: p = 0.0003; I0 vs. I1: p = 0.0008 and I1 vs. I2I3I4: p = 0.43). Patients with at least semi-circumferential anastomotic ulcerations (A2 or A3) had more anastomotic occlusive manifestations than patients without (A0 or A1) (A0 vs. A2A3: p = 0.01; A0 vs. A1: p = 0.83; A1 vs. A2A3: p = 0.05). Conclusion A classification separating anastomotic and ileal lesions might be more appropriate to define post-operative endoscopic recurrence. Patients with ileal lesions, including mild ones (I1), could beneficiate from treatment step up to improve long-term outcome.

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Serial monitoring of faecal calprotectin for the assessment of endoscopic recurrence in asymptomatic patients after ileocolonic resection for Crohn’s disease: a long-term prospective study

Therapeutic Advances in Gastroenterology ◽

10.1177/1756283x16646562 ◽

2016 ◽

Vol 9 (5) ◽

pp. 664-670 ◽

Cited By ~ 17

Author(s):

Takayuki Yamamoto ◽

Takahiro Shimoyama ◽

Satoru Umegae ◽

Koichi Matsumoto

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Prospective Study ◽

Faecal Calprotectin ◽

Endoscopic Recurrence ◽

Asymptomatic Patients ◽

Ileocolonic Resection

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P288 Vedolizumab May Be An Effective Option For The Management Of Postoperative Recurrence Of Crohn’s Disease

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab076.412 ◽

2021 ◽

Vol 15 (Supplement_1) ◽

pp. S320-S320

Author(s):

F S Macaluso ◽

M Cappello ◽

F Crispino ◽

M Grova ◽

A C Privitera ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Therapeutic Option ◽

Postoperative Recurrence ◽

Clinical Failure ◽

Endoscopic Recurrence ◽

Ileocolonic Resection ◽

One Year ◽

Rutgeerts Score

Abstract Background The role of Vedolizumab (VDZ) as therapeutic option for the postoperative recurrence of Crohn’s disease (CD) following ileocolonic resection is currently unknown. We aimed to assess the effectiveness of VDZ in this setting. Methods All consecutive CD patients with an available baseline colonoscopy at 6-12 months from the ileocolonic resection and treated with VDZ for the postoperative recurrence after the baseline colonoscopy were extracted from the cohort of the Sicilian Network for Inflammatory Bowel Diseases (SN-IBD). The primary outcome was endoscopic success, assessed at the first colonoscopy following initiation of VDZ. In patients with Rutgeerts score i0 or i1 at baseline, endoscopic success was defined by maintenance of Rutgeerts score i0 or i1; in patients with Rutgeerts score ≥ i2 at baseline, it was defined as reduction of at least one point of Rutgeerts score. The secondary outcome was clinical failure, assessed at one year and at the end of follow-up. Results Seventy patients were included (median follow-up: 23.5 months). All 9 patients without endoscopic recurrence at baseline (Rutgeerts score i0 or i1) and available post-treatment colonoscopy maintained a Rutgeerts score i0 or i1 (treatment success: 100%). In patients with endoscopic recurrence (Rutgeerts score ≥ i2 at baseline), a reduction of at least one point in the Rutgeerts score was obtained in 20 out of 42 patients (47.6%). By combining the two subgroups, the overall endoscopic success was achieved in 29 out of 51 patients (56.9%). Furthermore, 14 out of 42 patients (33.3%) with endoscopic recurrence at baseline achieved a Rutgeerts score i0 or i1 at the subsequent colonoscopy. Clinical failure was reported in 13/70 patients (18.6%) at one year, and in 23/70 patients (32.9%) at the end of follow-up. A new resection was required in 7/70 patients (10.0%). Conclusion VDZ may be a therapeutic option for the management of postoperative recurrence of CD. Further studies are needed to confirm these results.

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