Su1384 Medical Prophylaxis After Ileocolic Resection for Crohn's Disease – No Need to Rush

Abstract

Background: Crohn's disease (CD) most commonly affects the terminal ileum, with a majority of patients ultimately requiring ileocolic resection. Histologic and immunologic evidence suggests that mucosal inflammation occurs early after exposure of the neoterminal ileum to autologous luminal contents. Therefore, early medical prophylaxis has been advocated to prevent endoscopic recurrence of CD. The purpose of this study was to evaluate whether the timing of medical prophylaxis after ileocolic resection affects endoscopic recurrence of CD. Methods: A single institution, prospectively maintained database was queried for CD patients undergoing ileocolic resection over a 13-year period ending January 2013. Patients were included if they underwent postoperative endoscopy within 12-months of surgery and were started on medical therapy using 5-aminosalicylates (5ASA), immunomodulators, or biologic agents prior to their first postoperative endoscopy. Patients were divided into two groups; those started on medical prophylaxis within 4 weeks of surgery (Early) and those who receivedmedical prophylaxis 4 weeks or more after surgery (Late). The primary endpoint was endoscopic recurrence (defined as a Rutgeerts' endoscopic score of i2, i3, or i4 at first postoperative endoscopy). Secondary endpoints included time to endoscopic recurrence, and any radiological, clinical and surgical recurrence. Results: The 165 study patients had a mean age (SD) of 32.2 (14.6) years and 91 (55%) were male (Table). Mean time to starting medical therapy was 3.8 (2) weeks. 99 patients (60%) were in the Early prophylaxis group and 65 (40%) were in the Late prophylaxis group. Compared to the Early prophylaxis group, the Late prophylaxis group was treated more commonly with biologics (p<0.001) and less commonly with 5-ASA (p=0.007) or immunomodulators (p=0.004). At a mean endoscopy time of 6.8 (2.4) months, 65 patients (39%) had endoscopic recurrence; 39 (39%) in the Early group and 26 (39%) in the Late group. There was also no significant difference in clinical or surgical recurrence between the Early versus Late prophylaxis patient groups. Subgroups analysis of patients treated postoperatively with non-biologic medical prophylaxis, biologic alone, or biologic with other agents, showed no significant difference in endoscopic recurrence between Early and Late prophylaxis patient groups. Conclusion: Althoughmedical prophylaxis after ileocolic resection for CD has been shown to reduce endoscopic recurrence, it may be safe to wait until patients are out of the initial perioperative period prior to initiating medical prophylaxis without any adverse effects on endoscopic recurrence.