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

Abstract

Background: The endoscopic Rutgeerts' score (RS) is widely used to guide post-operative management of patients with Crohn's disease (CD). It is unclear whether all lesions from the i2 category should be considered clinically relevant. The modified RS differentiates lesions at the anastomosis with or without < 5 isolated neo-terminal ileal erosions (i2a) from presence of ≥5 isolated neo-terminal ileal erosions with or without anastomotic lesions (i2b), but its predictive value has not been validated. We investigated if clinical relapse (CR) and need for endoscopic/surgical intervention (ESI) differ between i2a and i2b endoscopic recurrence (ER). Methods: This was a retrospective, single-center study including all consecutive patients with an i2 ER observed 6-12 months after right hemicolectomy with ileocolonic anastomosis. The modified RS was attributed based on the available endoscopic report and on the images captured during endoscopy. CR was defined as the occurrence of CD related symptoms along with biological, endoscopic (i3-i4) and/or radiologic signs of disease activity. ESI was defined as the need for balloon dilatation or stricturoplasty at site of the anastomosis, or new right hemicolectomy. Kaplan-Meier curves were plotted for time from index endoscopy to CR and ESI. Results: The study population consisted of 94 patients [43 males, median age at index endoscopy 37 years], operated between December 2000 and December 2013. At index endoscopy, 53 patients (56%) had an i2a ER, and 41 (44%) an i2b ER. At endoscopy, the two groups were not different regarding disease characteristics and post-operative prophylactic therapy. Medical treatment was optimized or initiated according to index colonoscopy in 8 (15%) patients with i2a and 20 (49%) with i2b ER (Odds ratio (OR) 5.2 (95%CI 2.0-14.6), p<0.001). During a median (IQR) follow-up of 78 (37-109) months, CR and ESI were observed in 47 (50%) and 21 (22%) patients, respectively. As shown in Figures 1 and 2, the modified i2a and i2b scores were not predictive of CR and ESI (Log Rank p=0.37 and p=0.10, respectively). Also after exclusion of patients with immediate post-endoscopy treatment optimization, the modified i2a and i2b scores were not predictive of CR and ESI (Log Rank p=0.73 and p=0.34, respectively). A previous ileocolonic resection (OR 2.0 (95%CI 1.1-3.9), p=0.04) was associated with CR; immediate post-operative prophylactic therapy by anti-TNF was protective against CR (p=0.03). Postoperative prophylactic therapy by thiopurine was protective against ESI (p=0.02). Conclusion: In this cohort, no difference was observed in terms of clinical relapse and need for endoscopic or surgical intervention between i2a and i2b ER after a right hemicolectomy with ileocolonic anastomosis in CD patients. Further study is needed to confirm these results and evaluate the outcome of Rutgeerts' score i2 patients. (Figure Presented).