S954 Impact of Isolated Anastomotic Inflammation on Future Disease Progression: A Systematic Review and Meta-analysis

Abstract

Introduction: There is conflicting data on the impact of isolated anastomotic lesions on Crohn’s disease (CD) recurrence following ileocolic resection (ICR). We aimed to evaluate the risk of endoscopic and surgical postoperative recurrence (POR) in individuals with isolated anastomotic lesions (Rutgeerts’ i2a) compared to mild ileal disease (Rutgeerts’ i2b). Methods: A comprehensive search of multiple databases (through June 2021) was performed to identify studies that reported outcomes using modified Rutgeerts’ score after ICR in patients with CD. Outcomes assessed included endoscopic and surgical POR. Endoscopic POR was defined as progression to i3 or i4 disease on subsequent colonoscopy and surgical POR was defined as need for further resection after index ICR. The odds ratio were calculated using random effect models. Results: A total of 393 patients (i2a =203 and i2b =190) were included from 4 studies. The median age was 36 years (range 26 – 48) and 51% were females. Mean follow up ranged from 2-5 years. A total of 175 patient had repeat colonoscopy on follow up. There was no significant difference rate of endoscopic POR between i2a and i2b disease with odds ratio of 0.62 (95% confidence interval, 0.15 – 2.57, I2=76%) from 3 studies (P= 0.51) (Figure 1a). Similarly, rates of surgical POR were also similar between i2a and i2b group with OR of 0.74 (95% CI, 0.32 – 1.73, I2=11%) (P=0.49) (Figure 1b). We were unable to compare rates of clinical POR due to only 2 studies reporting this outcome. Conclusion: In this meta-analysis of POR risk following ICR for CD, there were no significant differences in endoscopic or surgical recurrence rates by Rutgeerts’ i2 subcategory. The study is limited by sample size and significant heterogeneity for endoscopic recurrence. Larger studies with congruent outcomes are needed to validate these findings and resolve differences.Figure 1.: Forrest plot showing odds ratio of endoscopic postoperative recurrence (A) and surgical postoperative recurrence (B) between i2a and i2b groups.