IBD

14 - Anastamotic Ulcers After Ileocolic Resection Predict Crohn's Disease Recurrence

Monday, October 8
2:45 PM - 2:55 PM
Location: Terrace Ballroom 4 (level 400)

Category: IBD
Sarah Lopatin, MD1, Daniel Castaneda Mayorga, MD1, Benjamin Cohen, MD2, Robert Hirten, MD2
1The Mount Sinai Hospital, New York, NY; 2Icahn School of Medicine at Mount Sinai, New York, NY

Introduction: Approximately 50% of patients with Crohn’s disease (CD) require surgery within 10 years of diagnosis. Ileocolic resections (ICR) are common with recurrent inflammation observed in approximately 70% of patients within 1 year. Inflammation in the neo-terminal ileum is graded using the Rutgeerts score (i0-i4) and predicts clinical recurrence. Anastomotic ulcerations (AU) involving the ileocolic anastomosis are excluded from this grading system. Their epidemiology and clinical significance are unknown.

Methods: Patients who underwent an ICR for CD at Mount Sinai Hospital from January 1, 2008 to January 1, 2017, with a subsequent colonoscopy and Rutgeerts score, were identified. Patient, disease and surgical characteristics, and post-op colonoscopy findings were collected. Factors associated with an AU were evaluated using Chi-square. In patients in endoscopic remission (i0/i1) on the 1st post-op colonoscopy the impact of an AU on the composite endpoint of CD reoccurrence (≥i2) or subsequent ICR was assessed using Chi-square. Multivariate regression was performed including variables with a p≤ 0.2. Descriptive statistics, Chi-Square, Fisher’s exact test, and logistic regression were done using SPSS v24.

Results: 184 subjects were identified with up to 60 months follow-up from ICR. Patient, disease and surgical characteristics and 1st postoperative colonoscopy findings are in Table 1.  Age, disease duration, anastomotic surgical technique, gender, smoking at ICR, prior ICR, presence of an abscess, ICR complications, biologic agents pre-ICR and biologics pre-1st colonoscopy were not associated with AU formation (p≥0.05). On univariate analysis an AU was the only factor associated with the composite endpoint (p=0.012). Age, disease duration, anastomotic surgical technique, biologic use prior to the 1st colonoscopy, biologic pre-ICR, and ICR complications were not associated with the composite endpoint. On multivariate analysis, only AU at the 1st colonoscopy was significantly associated with the composite endpoint (OR 3.862, p=0.015).

Discussion: Anastomotic ulcers are common after ICR occurring in more than half of subjects with CD. While no identifiable risk factors for their development are evident, they are associated with CD recurrence or the need for future ICR. While excluded from the Rutgeerts scoring system they represent a risk factor for postoperative disease progression and may necessitate treatment escalation.

Table 1

Disclosures:
Sarah Lopatin indicated no relevant financial relationships.
Daniel Castaneda Mayorga indicated no relevant financial relationships.
Benjamin Cohen indicated no relevant financial relationships.
Robert Hirten indicated no relevant financial relationships.

Sarah Lopatin

The Mount Sinai Hospital
New York, New York

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