P138 Isolated ileal blind loop inflammation after ileocolonic resection in Crohn's disease: An often neglected diagnosis with an unfavourable prognosis. (16th January 2018)

• Record Type: Journal Article
• Authors: Beelen, E M J; de Vries, A C; Bodelier, A G; Molenaar, J; Schouten, W R; van der Woude, C J
• Is Part Of: Journal of Crohn's and colitis. Volume 12:Number 1(2018:Jan.)Supplement 1
• Page Start: S164
• Page End: S165
• Publication Date: 2018-01-16
• Subjects: Inflammatory bowel diseases -- Periodicals; 616.344005
• DOI: 10.1093/ecco-jcc/jjx180.265
• Languages: English
• ISSNs: 1873-9946

Abstract

Abstract: Background: Endoscopic recurrence at the ileocolonic anastomosis and in the neoterminal ileum is commonly classified using the Rutgeerts score to predict the clinical course of postoperative Crohn's disease (CD). Isolated ileal blind loop inflammation (IBLI) is not included in the Rutgeerts score and its prognosis is unknown. Therefore, we aimed to assess the rate of occurrence, risk factors and prognosis of IBLI in postoperative CD patients. Methods: CD patients after ileocolonic resection in the past 20 years were identified in the hospital endoscopy database of one academic and one large teaching hospital. Endoscopy reports were evaluated to identify IBLI diagnosis, defined as isolated inflammation of the ileal blind loop with or without aphtous ulcers confined to the anastomosis. Patients without IBLI after ileocolonic resection were included as a background population. Risk factors for IBLI were explored using Cox regression. Prognosis was assessed as clinical outcome (start or step-up of medical therapy within 3 months), endoscopic outcome (recurrence defined as Rutgeerts >i2) and surgical outcome (re-resection). Results: The identified cohort comprised 341 CD patients after ileocolonic resection (132 (39%) male, median age 30 years (IQR 23–40) at first resection). Endoscopists described the ileal blind loop in 125 (37%) cases. Occurrence rate of IBLI was 43/341(13%) patients, diagnosed after a median of 2.8 years (IQR0.7–5.9) after most recent resection. In 19 patients true IBLI was observed, whereas 24 patients had IBLI with ulcers confined to the anastomosis. In univariate analysis a family history of IBD and re-resection were significant risk factors for IBLI. In multivariate analysis only family history of IBD remained a significant risk factor (HR 2.9; 95% CI 1.3–6.3). Thirty-two (74%) patients were not in clinical remission at the time of endoscopy revealing IBLI. Start or step-up therapy was initiated in 10/32 (31%) patients within a median of 0.8 months. Endoscopic recurrence occurred in 4/38 (11%) IBLI patients without re-resection during follow-up, as compared with 45/298 (15%) in the background population ( p = 0.452). Five (16%) IBLI patients underwent a re-resection within a median of 4 months. In three of these patients a revision of the anastomosis was performed, after which these patients experienced immediate relieve of symptoms. Conclusions: The occurrence rate of IBLI is unknown as the blind ileal loop is often disregarded during postoperative ileocolonoscopy. Nevertheless, this study suggests an unfavourable prognosis of IBLI, as a high risk of surgical recurrence during follow-up is observed. Therefore, the blind ileal loop in postoperative CD patients deserves to be looked into further both in clinical practice and in prospective research.