P686 Endoscopic follow-up and therapeutic attitude after ileocolonic resection in a nationwide Spanish cohort of Crohn's disease patients: PRACTICROHN study. (16th January 2018) - Barreiro-de Acosta, M
Abstract: Background: Endoscopic recurrence precedes clinical recurrence after ileocolonic resection for Crohn's disease (CD). An ileocolonoscopy within the first year after surgery is recommended to make timely treatment decisions. The aim of our study was to describe the endoscopic monitoring and treatment decisions within the first year after surgery in CD patients operated on between 2007 and 2010. Methods: PRACTICROHN was a study that included patients aged ≥18 years old from 26 Spanish hospitals who underwent CD-related ileocolonic resection with ileocolonic or ileorectal anastomosis between 2007 and 2010. Clinical data were retrospectively collected from clinical charts during 5 years follow-up after surgery. Categorical variables were compared with the χ2 test or Fisher's exact test. Results: 314 patients (mean age 40 years [SD 13], 48% men) were analysed, from which 262 (83.4%) underwent colonoscopy, while 52 (16.5%) lacked it. First endoscopy was performed mainly within the first year after surgery (45.5%) mainly as planned monitoring (66.4%). In total, 30.3% of the patients underwent planned endoscopy within first year after surgery. By year, a positive trend was found in the number of both total and "planned" endoscopies carried out (Figure 1). 74.8% of the patients had a medication change, mainly within the first year after surgery (47.1%). Median time to first medication change was 10 (IQR 4–22) months. The most frequent therapeutic decision was the introduction or dose escalation of thiopurines, or the addition or change to a more potent agent (68.1%). 40.2% of the patients showed a Rutgeerts score ≥ i2. This group showed a higher percentage of patients having a medication change, as compared with those with a Rutgeerts score <i2. The leading reason for the change medication was endoscopic without clinical recurrence, in those with a Rutgeerst score ≥i2 (Table 2). Conclusions: The number of planned endoscopies carried out within the first year after surgery increased significantly from 2007 to 2010 showing a steadily implementation of guidelines recommendations. Changes in medication within this period were more frequent in the setting of endoscopic recurrence. This study was funded by Merck Sharp and Dohme of Spain