P120 PRE-POUCH ILEITIS IS A RISK FACTOR FOR DEVELOPMENT OF CROHN’S DISEASE-LIKE COMPLICATIONS, NEED FOR BIOLOGIC THERAPY AND POUCH FAILURE

Abstract

Abstract Introduction Pre-pouch ileitis or afferent limb inflammation is generally considered to be suggestive of de novo Crohn’s disease in patients with ileal pouch. However, the data on whether these patients progress to develop CD-like complications is limited. We aim to study the evolution of pre-pouch ileitis in this study. Methods All patients who underwent an IPAA surgery by an expert surgeon between 1990 and 2018 for diagnosis of ulcerative colitis (UC) or inflammatory bowel disease-unclassified (IBD-U) at our institution and later went to develop pre-pouch ileitis were included. Patient charts were reviewed were reviewed subsequent to the diagnosis of pre-pouch ileitis to assess development of CD-like complications (non-anastomotic strictures and fistulae developing >6 months after ileostomy closure) or requirement of J-pouch surgery or ileostomy. Pre-pouch ileitis was defined by presence of erosions or ulcers in the afferent limb. Results 58 patients with J-pouch developed pre-pouch ileitis at a median of 21 months (range 1–216 months) from ileostomy closure. Baseline characteristics are shown in table 1. Median follow up duration after the diagnosis of pre-pouch ileitis was 48 months (range 2–204 months). 54/58 (93%) patients had concomitant pouchitis with pre-pouch ileitis. 36/58 (62%) patients were initiated on biologic therapy during their follow up course and 3/58 (5%) were treated with an immunomodulator. 20/58 (35%) patients developed Crohn’s disease-like complications (10 developed non-anastomotic strictures and 10 developed perianal complications) at a median follow up of 17 months (range 2–85 months) from the diagnosis of pre-pouch ileitis. 5/58 (8.6%) needed endoscopic stricture dilation and 6/58 (10%) needed perianal surgery for fistula or abscess. Pouch failure occurred in 5/58 (9%) of patients (3 with pouch resection, 1 with pouch revision and 1 with permanent ileostomy), while 3/58 (5%) patients required temporary ileostomy. Conclusions Patients who develop pre-pouch ileitis are at high risk of developing CD-like complications (non-anastomotic strictures and perianal complications). The risk of pouch failure and requirement for endoscopic procedures or surgery in this cohort also appears to higher than traditionally reported in patients with pouchitis. Hence, pre-pouch ileitis should be considered suggestive of Crohn’s disease and treated aggressively.