Su1197 Recurrence and Long Term Evolution of Small Bowel (SB) Lesions After Curative Ileo-Colon Resection in Crohn's Disease (CD) Patients: A Prospective Follow-up Study

Abstract

Previous radiological and endoscopic studies limiting their assessment to luminal alterations and/or upper GI and terminal ileum, and performed at patients or investigators' discretion could not provide a systematic prospective evolution of long-term CD SB lesions .Small intestine contrast ultrasonography (SICUS) is as accurate as (a) endoscopy to assess in operated patients the presence and severity of CD recurrence (1) and (b) surgery to assess the presence and extension of SB CD lesions (2). Aim. To assess, by means of SICUS in CD patients submitted to curative ileo-colonic resection and treated with immunosuppressive or biological therapy, the onset and long-term evolution of SB CD lesions in comparison to no, or mesalazine, therapy (not treated patients). Subjects and Methods. Follow-up (FU) visits and SICUS were carried out 6-12 monthly for 65±35.3 months in 60 operated patients (M 36, age at diagnosis 34.5±14 yrs); non treated patients 36/60. SICUS was performed after the ingestion of 375 ml of macrogol contrast solution as previously described (1). Results. Neo-terminal ileal recurrent lesions occurred in 48/60 (80%) patients at 20±21.8 months after surgery. No recurrence was detected in 9/36 of non treated patients (FU 54±38.5 months, range 12-120). Non-treated and treated patients did not differ in terms of median age at diagnosis (33 vs 31.5 yrs), extension of ileo-colonic resection (40 vs 25.5 cm) and time interval between surgery and first visit (6 vs 6.5 months). Median length of FU was longer in treated vs not-treated patients (69 vs 42 months, p=0.03). In not-treated patients recurrent lesions occurred in 16/27 after ≤ 12 months with a mean extension of 8.3±9.4 cm (last FU extension 12±10.4 cm), in 3/27 after ≤ 24 months with a mean extension of 19.8±19.8 cm (last FU extension 28±33 cm), in 1/27 after ≤ 36 months with an extension of 4 cm (last FU extension 4 cm), in 2/27 after ≤ 48 months with a mean extension of 4.8±2 cm (last FU extension 10.5±6.5 cm) and in 5/27 after . 48 months with a mean extension of 2.3±2.5 cm (last FU extension 4.5±2.3 cm). In treated patients recurrent lesions occurred in 15/21 after ≤ 12 months with a mean extension of 9±7 cm (last FU extension 8.5±9.5 cm), in 1/21 after ≤ 24 months with a extension of 10 cm (last FU extension 0.5 cm), in 2/21 after ≤ 36 months with a mean extension of 6.5±0.7 cm (last FU extension 18±7 cm), in 3/21 after ≤ 48 months with a mean extension of 1.4±1.3 cm (last FU extension 4.2±6.8 cm). Conclusions. SB CD recurrence occurred in 80% of the operated patients, more than 50% within the first year. An early recurrence of CD lesions appears to be associated with a greater extension compared to a later recurrence and immunosuppressive and biological therapies appear to delay the evolution of CD SB lesions. 1) Pallotta N et al BMC gastroenterology 2010;2) Pallotta N et al IBD 2012