P2196 - Early, Severe Postoperative Recurrence of Crohn’s Disease – Natural History, Predictors, and Outcomes

Hareem Syed, MD¹, Adel Hajj Ali, MD¹, Abel Joseph, MD¹, Ravi S. Shah, MD¹, Salam Bachour, MD, MS², Terry Li, MD³, Jessica H. Hu, BS⁴, Vall Vinaithirthan, MD⁵, Jeffrey D. Kovach, BS, MS¹, Miguel Regueiro, MD⁶, Edward Barnes, MD, MPH, FACG⁷, Jordan Axelrad, MD, MPH⁸, Benjamin Click, MD⁹, Ben Cohen, MD, MAS^1
1Cleveland Clinic, Cleveland, OH; ²Brigham and Women's Hospital, Harvard Medical School, Boston, MA; ³NYU Langone, New York, NY; ⁴UNC School of Medicine, Chapel Hill, NC; ⁵University of Colorado, South Burlington, VT; ⁶Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH; ⁷University of North Carolina at Chapel Hill, Chapel Hill, NC; ⁸NYU Grossman School of Medicine, New York, NY; ⁹University of Colorado, Denver, CO

Introduction: Majority of individuals with Crohn's disease (CD) who undergo ileocolonic resection (ICR) will develop endoscopic postoperative recurrence (ePOR) within one year. However, the rates of early severe ePOR , its predictors, and the response to therapeutic interventions have not been defined in real-world data.

Methods: We performed a multi-center retrospective observational cohort study of CD patients who underwent ICR between 2009-2021. Patients who had ileocolonoscopy within 18 months of ICR were included. The primary outcome of the study was early, severe ePOR defined as a Rutgeerts score (RS) of i3 or i4 on postoperative ileocolonoscopy within 18 months. Association between perioperative risk factors and early severe ePOR was evaluated. Rates of surgical recurrence, therapy changes, and subsequent ileocolonoscopy findings were assessed.

Results: 737 patients with CD who had an ileocolonoscopy within 18 months of their index ICR were identified. Overall, 6.4% of patients had RS i3 (n=34, 4.6%) or i4 (n=13, 1.8%) ePOR within 18 months (Table 1). On univariable and multivariable analysis, there was no significant association found between severe ePOR and age (< 30 years vs > 30 years), history of ≥2 prior ICR, absence of diverting stoma or use of post-operative biologic prophylaxis. Rates of surgical recurrence in patients with severe ePOR diagnosed within 6 months (0%), 12 months (5.1%) and 18 months (6.4%) were similar to patients with i0-i2a and i2b disease in their respective time periods (p > 0.05 ). The median time to surgery in patients with severe ePOR within 18 months (458 [424,561] days) was much shorter than patients with i0-i2a (1371 [420, 1967] days) and i2b (1491 [796,2006] days). The most common treatment change following diagnosis of early severe ePOR was initiation of a new biologic (38.3%), followed by new immunomodulator (6.4%), optimized current biologic (4.3%) or immunomodulator (2.1%). Among those for whom follow-up ileocolonoscopy data was available after treatment change (n=9) the median time to next ileocolonoscopy was 182 [132-233] days and all patients started on a new biologic had endoscopic improvement (Figure 1).

Discussion: The incidence of early severe ePOR in patients with CD is low. This severe subgroup of patients appears responsive to biologic treatment changes. Prospective studies are needed to identify predictors for ePOR and refine treatment algorithms for these patients.



Disclosures:


Hareem Syed, MD¹, Adel Hajj Ali, MD¹, Abel Joseph, MD¹, Ravi S. Shah, MD¹, Salam Bachour, MD, MS², Terry Li, MD³, Jessica H. Hu, BS⁴, Vall Vinaithirthan, MD⁵, Jeffrey D. Kovach, BS, MS¹, Miguel Regueiro, MD⁶, Edward Barnes, MD, MPH, FACG⁷, Jordan Axelrad, MD, MPH⁸, Benjamin Click, MD⁹, Ben Cohen, MD, MAS¹. P2196 - Early, Severe Postoperative Recurrence of Crohn’s Disease – Natural History, Predictors, and Outcomes, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.