P-159 The Factors Influencing Postoperative Surgical Recurrence in Crohnʼs Disease

Abstract

BACKGROUND: Postoperative recurrence is inevitable in almost all Crohn's disease patients. In result, multiple bowel resections may lead to short bowel syndrome, which may affect the patient's life. Therefore, we need to seek for optimal strategies to prevent progression of the disease postoperatively. Lately, anti-tumour necrosis factor alpha (TNFa) agents and endoscopic balloon dilatation have been used widely, and treatment strategy has been changing. This study was aimed to clarify which therapy was the most efficient to suspend the postoperative surgical recurrence in Crohn's disease in the era of these novel therapies. METHOD(S): Seventy operations were undergone in 46 Crohn's disease patients. There were 32 males and 14 females. Clinical data were obtained by retrospective chart review. The age at surgery was 19-74 (median: 34.5), and the duration of Crohn's disease was 0-30 (median: 8.5) years. The observation period ranged 100 to 7758 (mean: 1671) days. The therapies analysed were aminosalicylates, immunomodulators (azathiopurine, 6-mercaptopurine), anti-TNFa agents (infliximab, adalimumab), nutritional therapy including elemental diet, and endoscopic balloon dilatation. Survival curves were drawn, and Log-rank test was employed to evaluate statistically for univariate analysis. We ran proportional hazard model for multivariate analysis. A p value of <0.05 was considered to be significant. RESULT(S): The patients who underwent anti-TNFa therapy had statistically better prognosis than those without (P = 0.0276). Balloon dilatation seemed to be useful, because the prognosis of the patients who received dilatation technique had better prognosis (P = 0.0167). Immunomodulators were effective to prevent surgical recurrence with statistical significance (P = 0.0460). Patients who maintained elemental diet (more than 900 Kcal/day) had statistically better prognosis than those without or with lower quantity (P = 0.0010). By multivariate analysis, the only significant factor was the nutritional therapy (P = 0.0186), followed by endoscopic balloon dilation therapy (P = 0.0572). CONCLUSION(S): Anti-TNFa therapy, immunomodulators, endoscopic balloon dilatation therapy, and elemental diet therapy were effective to suspend postoperative recurrence in Crohn's disease by univariate analyses. Elemental diet and, possibly, endoscopic dilatation remained favourable by multivariate analysis. (Graph presetned).