P023 THE ASSOCIATION BETWEEN BIOLOGIC USE AND SPECIMEN LENGTH IN CROHN’S DISEASE

Abstract

Abstract Introduction Despite advances in medical management, including the use of biologic agents, up to 80% of Crohn’s patients (CD) ultimately require operative intervention. Additionally, these patients are at risk for additional operative intervention within their lifetime. Given the risk of short bowel syndrome secondary to multiple bowel resections, conservation of bowel length is of paramount importance. A common yet unproven belief in the gastroenterology community is that intensive preoperative medical therapy might reduce the length of bowel removed at surgery. In this study, we compared specimen length in CD patients treated or not treated with biologic agents before surgery. Objective To determine if there is an association between biologic use and reduced specimen length after bowel resection. Methods Prospectively generated clinical profiles on consecutive CD patients undergoing their first ileocolic or small bowel resection between November 1999 to July 2019 were reviewed. Patients were classified into 2 groups: Group A patients were treated with biologic agents at any time before surgery while Group B patients had never received a biologic agent. Specimen length was determined by review of pathology reports. In patients with multi-segment resections, the sum of the specimens was recorded. The means of the two groups were compared using Students t test. Results The study cohort of 392 patients had a mean age of 36.2 (SD 15.9) years and included 53% males. Group A included 247 (63%) patients and Group B included 145 (37%) patients. Groups were comparable in terms of background demographics with the exception of age, use of preoperative immunomodulator therapy, and medical intractability as an indication for surgery (p value 0.01, <0.01, 0.02 respectively) The mean specimen length in Group A was 29.1cm compared to 29.9cm in the Group B (p=0.68). A subgroup analysis of ileocolic resections and small bowel resections was completed. Within the ileocolic group, there was no significant difference in length between groups with respect to the total specimen length (p=0.92), colonic portion (p=0.15), and small bowel portion (p=0.67). Analysis of small bowel resection specimens also found no difference in length between the groups (p=0.63). Conclusions The use of biologics in CD was not associated with reduced specimen length in ileocolic resections and in small bowel resections