Tu1085 POST-OPERATIVE CROHN'S DISEASE PATIENTS UNDERGOING COLONOSCOPY REQUIRE SIGNIFICANTLY MORE ANALGESIA & SEDATION COMPARED TO A NON-IBD POST-OPERATIVE POPULATION

Abstract

Rates of surgical intervention in Crohn’s disease have declined. However, a significant proportion of patients still require surgical resection and have been shown to have higher post-op pain scores and analgesia requirements. The aim of this study was to assess sedation requirements and comfort scores of post-operative Crohn’s disease patients at endoscopy. Patients with a previous intestinal resection undergoing colonoscopy 2014-2017 were identified via an electronic reporting system. Data regarding patient & disease characteristics, sedation requirements, Gloucester comfort scores and endoscopy reports were collected.Crohn’s disease patients with prior intestinal resection were compared to a non-IBD population post-intestinal resection. 212 patients were included. n=66 Crohn’s disease, n=2 UC and n=144 non-IBD patients underwent colonoscopy. Patient characteristics described in Table 1. 10.8% of patients had a documented history of chronic pain, hysterectomy or other relevant conditions that may affect comfort scores. 53% of patients with Crohn’s disease were on active treatment for IBD at the time of endoscopy. The median dose of midazolam administered was 3mg (IQR 2.12-4mg); median fentanyl dose was 50mcg. (IQR 50-75mcg).Significantly more midazolam was used in 2014 compared to procedures performed in 2016-17. (median 4mg vs 3mg; p=0.014). The median dose of Midazolam given was significantly higher in patients with Crohn’s disease (3mg IQR 3-5mg vs 3mg IQR 2-4; p=0.009).The median dose of fentanyl required was significantly higher in post-operative Crohn’s disease patients. (75mcg IQR 50-100mcg vs 50mcg ; p=0.001). The median comfort score in the Crohn’s disease patients was higher (indicating more discomfort) when compared to the non-IBD cohort. (median score 2 & 1 respectively) There was no significant difference in the proportion of patients with chronic pain etc or with multiple intestinal resections. (p=0.5 and p=0.41). There was a statistically significant difference in comfort scores with only n=25 Crohn’s disease patients (37.9%) having comfort score 1 when compared to n=79 non-IBD patients (55%) (p=0.04). Post-op Crohn’s disease patients with significant active endoscopic disease required significantly higher doses of midazolam compared to those patients with quiescent disease.(4mg IQR 3-5mg vs 3mg IQR 2.5-4mg;p=0.038) There was a trend towards significance in fentanyl dose. (75mcg IQR 50-100mcg vs 50mcg IQR 50-100mcg;p=0.06) Patients with Crohn’s disease undergoing colonoscopy in the post-operative setting have significantly higher analgesia requirements. Comfort scores are significantly worse when compared to non-IBD patients who have had similar intestinal resections. Endoscopists should use techniques e.g. CO2 insufflation, in addition to medication to ensure comfort amongst patients with Crohn’s disease.