P292 Endoscopic findings in ileocolic anastomoses: Crohn's disease vs oncologic surgery

Abstract

Abstract Background Endoscopic lesions of ileocolic anastomoses (ICA) are frequent findings in postoperative Crohn's Disease (CD) patients, associating with the risk of future recurrence by the modified Rutgeerts score (mRS). However, erosions and ulcers, mostly idiopathic, have also been described in colorectal cancer surgery anatomoses. Methods Primary aim: to evaluate the incidence of ICA lesions in CD and their impact on therapeutic choices. Secondary aim: to compare the endoscopic findings of ICAs in CD with those of patients operated for right colon adenocarcinoma (ICA-CRC). We performed a single-center retrospective study where we included all patients with CD submitted to ileocolic anastomoses and endoscopic reassessment up to 2 years after surgery (2010 to 2023). We randomly selected ICA-CRC patients with surveillance colonoscopy within the same interval. Results 23 patients with CD; 48% male; age at date of surgery 18-65 years (median 41). Prior therapy: corticotherapy 14%; thiopurines 26%; anti-TNF 44%. Surgery: ileo-cecal resection 65%; right hemicolectomy 26%; previous anastomosis resection: 9%. Clavien Dindo ≥1: 9%. Surveillance colonoscopy: 4-24 months after surgery (mean 11); ICA assessed in 83%; Lesions in ICA-CD 60%: ulcers 46%; erosions 43%; stenosis 4%; mRS ≥2a: 30%; Therapeutic change: 60%. 66 with ICA-CRC; mean age 67years; adjuvant therapy 26%; cardiovascular risk factors 22%; Clavien Dindo ≥1: 22%; Surveillance colonoscopy (mean): 12 months after surgery; ICA lesions 4% (erosions). No patient with erosions had symptoms and no therapy was introduced. Comparing the two groups: CD patients were younger (p <0.001), had fewer postoperative complications (p 0.01) and more often had ICA lesions (p <0.001). Conclusion ICA lesions in CD, compared to ICA-CRC, were more frequent, despite the younger age of the patients and fewer postoperative complications, which favors CD recurrence. Erosions in ICA-CRC appear to have no clinical relevance.