Resection Of Small Intestine Research Articles

Long-term survival and complications following small intestinal resection and partially stapled, functional end-to-end anastomosis.

The aim of the present study was to investigate the long-term survival and postoperative complications in horses that had undergone small intestinal resection and a modified anastomosis technique using a partially stapled, functional end-to-end anastomosis. Observational retrospective case series. A total of 25 horses underwent small intestinal resection and a partially stapled, functional end-to-end anastomosis. A modified technique to create a partially stapled, functional end-to-end anastomosis is described. The clinical case records of all horses that fulfilled the criteria between January 1, 2010 and January 1, 2020 were reviewed. Data on short-term survival and postoperative complications were collated. A telephone questionnaire of owners was undertaken to evaluate long-term survival. Duration of follow up was from one to 4232 days (median 785 days). A total of 21/25 (84%) of horses survived to discharge, 19/25 (76%) horses were alive at 6 and 12 months and 64% survived to 2 years. A total of 64% of horses developed at least one postoperative complication. Two horses developed a small intestinal volvulus necessitating repeat laparotomy. One horse had kinking at the anastomosis site diagnosed at post-mortem examination. Partially stapled functional end-to-end anastomosis technique in this study had similar short- and long-term survival to those reported in previous studies using handsewn techniques, but severe complications at the anastomosis site occurred in >10% of cases. The anastomosis technique described appears to have similar short- and long-term survival and complication rates, compared to more commonly used anastomosis techniques. However, there is potential for severe complications at the anastomosis site.

Mesenteric cysts.

<b>Introduction:</b> Mesenteric cysts (MCs) are a rare pathology of the abdominal cavity (with an incidence of 1/27.000 to 1/250.000 admissions) and less than 1000 cases have been described in the specialized literature.<b>Aim:</b> To identify the characteristics of clinical manifestations, diagnostics, and treatment of MCs.<b>Materials and methods:</b> Within 2001-2017, 17 consecutive patients with MCs were observed. Ultrasound scan (n = 17), computed tomography (n = 15), and magnetic resonance imaging (n = 1) were used to diagnose MC.<b>Results:</b> The mean age of patients with MCs was 43.4 3.5 years (range from 19 to 67), with a significant predominance of women (n = 14, 82.4%). The main clinical symptoms of MCs included abdominal pain (n = 9, 52.9%), pain + abdominal discomfort (n = 4, 23.5%), abdominal pain + nausea (n = 2, 11.8%), and abdominal discomfort (n = 2, 11.8%). In 13 (76%) cases, a palpable mass was noted in the abdominal cavity. According to imaging studies, the largest size of the MCs was 12.1 1.2 cm (from 5 to 20 cm) and the smallest - 8.6 0.8 cm (from 4 to 15 cm). The density of MC contents by computed tomography data varied from 2 to 26 HU. All patients underwent surgery via laparotomy. MCs were significantly more often located in the mesentery of the large bowel (n = 14, 82.4%) as compared to the small intestine (n = 3, 17.6%). The MCs of the small intestine in all cases were located in the mesentery of the jejunum, whereas in the colon lesions, they were distributed as follows: cecum (n = 1, 7.1%), ascending colon (n = 3, 21.4%), transverse colon (n = 7, 50%), and sigmoid colon (n = 3, 21.4%). Most MCs (n = 16, 94.1%) were enucleated, and only in one case segmental resection of small intestine with MCs was performed. The histopathological examination revealed: simple mesothelial MC - in 8 (47.1%), simple lymphatic MC - in 7 (41.2%), and lymphangioma - in 2 (11.7%) cases.<b>Conclusions:</b> MC is a rare pathology of abdominal organs. The clinical manifestations of MCs are nonspecific, and the final diagnosis becomes apparent only during surgery. In most cases, it is possible to perform MC enucleation without long-term recurrences.

Visceral to subcutaneous fat area ratio predicts severe abdominal adhesions in definitive surgery for anastomotic fistula after small intestine resection

Abdominal adhesions manifests following abdominal infections triggered by intestinal fistulas. The severity of such adhesions depends on the extent of fiber deposition and peritoneal fibrinolysis following peritoneal injury, which may be influenced by sustained inflammation within the abdominal cavity. In this regard, the visceral-to-subcutaneous fat area (VFA/SFA) ratio has been implicated as a potential marker of inflammation. This study aimed to explore the relationship between VFA/SFA and abdominal adhesions. This multicenter study was conducted across four tertiary institutions and involved patients who had undergone definitive surgery (DS) for intestinal fistula from January 2009 and October 2023. The presence of abdominal adhesions was determined intraoperatively. VFA/SFA was investigated as a potential risk factor for severe adhesions. The study comprised 414 patients with a median age of 50 [interquartile range (IQR) 35–66] years and a median body mass index of 20.0 (IQR 19.2–22.4) kg/m2, including 231 males with a median VFA/SFA of 1.0 (IQR 0.7–1.2) and 183 females a median VFA/SFA of 0.8 (0.6–1.1). VFA/SFA was associated with severe abdominal adhesions in males [odds ratio (OR) = 3.34, 95% CI 1.14–9.80, p = 0.03] and females (OR = 2.99, 95% CI 1.05–8.53, p = 0.04). J-shaped association between VFA/SFA ratio and severe adhesions was revealed in both sex. The increasing trend can be revealed when OR more than 0.8, and 0.6 in males and females respectively. Preoperative VFA/SFA demonstrates predictive value for statues of severe abdominal adhesions in DS for anastomotic fistula after small intestine resection.

Pathological Findings in the Carcass of a Dog following Ovariohysterectomy, and Intestinal Resection and Anastomosis

This report presented the gross and histopathological findings in the carcass of a Nigerian Indigenous Dog (NID) following ovariohysterectomy, intestinal resection and anastomosis. The carcass of a 9-month-old NID was presented to the Necropsy Unit of the Veterinary Teaching Hospital, Ahmadu Bello University Zaria, Nigeria. History was obtained, general examination of the carcass and necropsy were conducted. History revealed sudden death 2 days post-abdominal surgical procedures (ovariohysterectomy, and small intestinal resection and anastomosis). The clinical signs observed before death were weakness and dyspnea, while mild tick infestations and bilateral congested ocular mucus membranes were on general examination of the carcass. The gross pathological findings were hemorrhagic trachea, congested and hemorrhagic lungs, enlarged heart with epicardial and endocardial hemorrhages, enlarged and congested liver, enlarged spleen, hemorrhage in the gastric mucosa, intestinal hemorrhages, and an area of hemorrhagic infarct at the intestinal anastomosed site. On histopathological examination, there was slightly thickened interalveolar walls with inflammatory cellular infiltrations, cardiac hemorrhage, and hepatic congestion. These gross and histopathological findings suggest possible systemic complications, thus, emphasizing the importance of comprehensive pre-operative assessment, and post-operative care and monitoring in veterinary surgeries.

Identification of risk factors for the development of complications and the outcome of horses undergoing small intestinal resection and anastomosis

Identification of risk factors for the development of complications and the outcome of horses undergoing small intestinal resection and anastomosis

Characteristics of chronic enteropathy associated with SLCO2A1 gene (CEAS) in children, a unique type of monogenic very early-onset inflammatory bowel disease

Background Chronic enteropathy associated with SLCO2A1 gene (CEAS) is a unique type of inflammatory bowel disease. CEAS is monogenic disease and is thought to develop from childhood, but studies on pediatric CEAS are scarce. We analyzed characteristics of pediatric CEAS.MethodsEleven patients diagnosed with CEAS at Seoul National University Children’s Hospital were identified and analyzed. Clinical data of patients were collected. Sanger sequencing of SLCO2A1 was performed on all patients.ResultsPatients were diagnosed at a median age of 16.0 years (IQR 11.0 ~ 20.0), and the median age at symptoms onset was only 4.0 years (IQR 2.5 ~ 6.0). Growth delay was observed at the time of diagnosis. Patients showed multiple ulcers or strictures in the small intestine, while the esophagus and colon were unaffected in any patients. Almost half of the patients underwent small intestine resection. The major laboratory features of pediatric CEAS include iron deficiency anemia (IDA), hypoalbuminemia, and near-normal levels of C-reactive protein (CRP). Two novel mutations of SLCO2A1 were identified. The most prevalent symptoms were abdominal pain and pale face. None of the immunomodulatory drugs showed a significant effect on CEAS.ConclusionsPediatric CEAS typically develop from very young age, suggesting it as one type of monogenic very early onset inflammatory bowel disease. CEAS can cause growth delay in children but there is no effective treatment currently. We recommend screening for SLCO2A1 mutations to pediatric patients with chronic IDA from a young age and small intestine ulcers without elevation of CRP levels.

Clinical characteristics and literature review of ectopic gastric mucosa in the small intestine

The study aims to summarize the clinical characteristics of patients with ectopic gastric mucosa in the small intestine, comparing clinical presentation differences between domestic and foreign patients through literature review. The clinical characteristics of cases diagnosed with ectopic gastric mucosa in the small intestine at Peking Union Medical College Hospital from January 2000 to January 2024 were retrospectively analyzed. By searching databanks, such as PubMed, EMBASE, the Cochrane Library, Wanfang, VIP, CNKI, and etc (the inclusion period was from the establishment of the database to January 1, 2024). The literature review was conducted on ectopic gastric mucosa in the small intestine. A total of 10 cases were included, all male, age [M (Q1, Q3)] was 27 (13-69) years old. Gastrointestinal bleeding was the first manifestation in most cases, with severe cases leading to hemorrhagic shock. Abdominal CT indicated local intestinal wall thickening and luminal narrowing in 3 cases. Four cases lesions were located at the beginning of the jejunum and 6 lesions were located in the end segment of ileum. All cases underwent local lesion resection, with postoperative pathology confirming ectopic gastric mucosa. Symptoms disappeared postoperatively, with a follow-up period of 0.5-3.0 years. Literature review indicates that the main clinical manifestation of gastric mucosa ectopia in the small intestine in China is gastrointestinal bleeding, while foreign patients are often complicated with intestinal duplication and intussusception, with abdominal pain and vomiting as the primary and main symptoms. The occurrence rate of intestinal obstruction in female patients, both domestically and abroad, is higher than that in male patients. The occurrence rate of ileal lesions with intestinal obstruction and small intestinal duplication is higher than that of duodenal lesions in both domestic and foreign patients. Local small intestine resection is an effective treatment method with generally good prognosis. Ectopic small intestinal mucosa is relatively rare, with symptoms of gastrointestinal bleeding and intestinal obstruction being common presentations, which can serve as one of the differential diagnoses for unexplained gastrointestinal bleeding.

Retrospective evaluation of the effects of a single intraoperative dose of dexamethasone in horses undergoing exploratory laparotomy for small intestinal lesions (2008-2019): 240 cases.

To determine the effect of a single intraoperative dose of dexamethasone on the risk of postoperative reflux (POR) in horses undergoing small intestinal surgery and to investigate its association with incisional complications and short-term survival. Retrospective cohort study over an 11-year period (2008-2019). UK-based private referral center. Two hundred and forty client-owned horses >6months of age undergoing exploratory laparotomy for treatment of a small intestinal lesion. Ninety-seven horses received a single intraoperative dose of dexamethasone (0.1mg/kg, IV). Of 97 horses that received dexamethasone, 52 (53.6%) required small intestinal resection. Of 143 horses that did not receive dexamethasone, small intestinal resection was performed in 78 (54.5%). A total of 70 horses (29%) developed POR. There was no difference in the risk of POR between horses that received dexamethasone (25/97; 26%) and those that did not (45/143; 31%, P=0.34). Risk factors associated with the development of POR included small intestinal resection (odds ratio [OR]: 4.55, 95% confidence interval [CI]: 2.27-9.11, P<0.001), a PCV >40% 24hours postoperatively (OR: 4.11, 95% CI: 2-8.45, P<0.001), and a WBC count >10×109/L on admission (OR: 3.29, 95% CI: 1.47-7.41, P=0.004). Dexamethasone was not associated with the odds of POR. Horses undergoing repeat laparotomy had a higher risk of incisional infection (OR: 8.07, 95% CI: 1.98-32.81, P=0.004). Dexamethasone administration was not associated with incisional infection. The development of POR was negatively associated with short-term survival (OR: 0.07, 95% CI: 0.03-0.17, P≤0.001). Dexamethasone administration was not retained in the final multivariable model for survival. Intraoperative dexamethasone was not associated with the development of POR in this study population, nor did it have an effect on postoperative survival or incisional infection in horses undergoing surgical management of small intestinal disease.

MALIGNANT MELANOMA – METASTASES IN GIT: REPORT OF 4 CASES AND LITERATURE REVIEW

Purpose: We present four cases of malignant melanoma metastases in GIT. The symptoms which led to the hospitalization of the patients were ileus in two cases, hematemesis and hematochezia. Results: We performed operative treatment - small intestinal resection because of intussusception followed by anastomosis in three patients and in one patient, liver resection and bitruncular sigmostomy. The histopathology revealed metastases for malignant melanoma. All of the patients had previous operation for a skin form of malignant melanoma, and chemotherapy or immunotherapy was performed. The patients had a postoperative period without complications. Conclusions: Malignant melanoma is a widely common disease. It is the third neoplastic diseases which give metastases in the small intestine. Malignant melanoma metastases in the GIT are initially asymptomatic, but in time, they manifest with clinical presentation of ileus or bleeding from the GI tract.

Case Report: Metachronous intussusception: A complex case report of small intestinal adenocarcinoma

Small intestinal adenocarcinomas, comprising less than 5% of digestive cancers, present diagnostic and therapeutic intricacies often overshadowed by more common digestive malignancies. This report highlights the unique metachronous characteristic of the case, emphasizing the presence of intussusception, to contribute valuable knowledge and refine medical approaches for optimizing outcomes in these rare and complex scenarios. A 73-year-old male, previously operated for right colon adenocarcinoma, developed metachronous liver metastasis a year later, successfully treated. Presenting with acute intestinal obstruction, imaging confirmed mechanical obstruction, prompting small intestine resection and stoma creation. The postoperative phase, characterized by meticulous care, ensures ongoing close oncological follow-up for this complex medical journey, with the added complication of intussusception. Amid the rarity of small intestinal adenocarcinomas in digestive cancers, our unique case sheds light on the challenges in diagnosis and treatment, particularly highlighting the presence of intussusception. The distinctive approach of small intestine resection and stoma creation underscores ongoing debates on adjuvant chemotherapy, reflecting an evolving management landscape. This underscores the crucial role of continuous research and multidisciplinary strategies in optimizing outcomes for patients facing this uncommon malignancy complicated by intussusception. This report provides valuable insights into the complexities of diagnosing and managing small intestinal adenocarcinomas, particularly when complicated by intussusception. As we navigate this nuanced medical terrain, continuous research and multidisciplinary approaches remain pivotal for refining our understanding and optimizing outcomes in small intestinal adenocarcinomas.

P314 Serum levels of Leucin-Rich α2 Glycoprotein predicts endoscopic mucosal healing of Crohn's disease

Abstract Background It has been suggested that serum levels of Leucin-Rich α2 Glycoprotein (LRG) correlate with disease activity of Crohn’s disease (CD). Small bowel capsule endoscopy (SBCE) can be performed together with ileo-colonoscopy (ICS) at the same day to assess mucosal healing in patients with clinically quiescent CD. The aim of this study was to determine the usefulness and a cut off value of LRG that indicate mucosal healing in patients with CD. Methods Clinically quiescent CD (CDAI&amp;lt;150) patients without perianal lesions received SBCE and ICS at the same day between July 2021 and August 2023 were included. Serum levels of CRP and LRG were measured in the time frame of median 23 days before or after the exam (IQR 14, 43). Endoscopic findings were evaluated by modified simple endoscopic score for CD (mSES-CD) composed of 3 variables (size of ulcers, proportion of ulcer surface and disease affected surface) of each 7 segments (jejunum, upper ileum, lower ileum, right colon, transvers colon, left colon and rectum). Mucosal healing was defined by the mSES-CD score of 0. Results Among 51 CD patients enrolled, 88.2% were male with the median age of 20 (IQR 22, 35) and the disease duration of 69 months (IQR 23, 35). History of small or large intestinal resection was found in 15 (29.4%) and 14 (27.4%) cases, respectively. The median CRP and LRG were 0.1 mg/dL (IQR 0.1, 0.4), and 12.3 μg/mL (IQR 8.8, 18.3), respectively. The median mSES-CD was 3 (0,6%), and 20 (39.2%) cases were score 0. There was a high correlation between LRG and CRP levels (p&amp;lt;0.0001, r=0.78), and the cut of value of LRG that indicates negative CRP (&amp;lt; 0.4 mg/dL) was 16.6 μg/mL; area under the curve (AUC) of ROC analysis 0.91, sensitivity 90.0%, specificity 84.8%. In addition, a significant correlation between LRG levels and mSES-CD was found (p&amp;lt; 0.0001, r= 0.65), while no correlation between CRP and mSES-CD (p=0.72, r= 0.27). The cut off value of LRG that indicates mucosal healing was 10.2 μg/mL (AUC 0.915, sensitivity 89.7%, specificity 85.7%) with positive predictive value of 92.9% and negative predictive value of 80.0%. Conclusion LRG can be a reasonable biomarker to monitor disease status of CD especially in clinically quiescent patients with small bowel CD. LRG values less than 10.2 μg/mL indicates endoscopic mucosal healing in patients with CD.

ПРИМЕНЕНИЕ ШОВНОГО МАТЕРИАЛА С АНТИБАКТЕРИАЛЬНЫМ ПОКРЫТИЕМ ПРИ РЕЗЕКЦИИ ТОНКОЙ И ТОЛСТОЙ КИШКИ

The study reviewed the scientific literature available on the CyberLeninka and eLIBRARY.RU electronic scientific libraries, as well as the PubMed database. The study focused on the use of suture material with antibacterial triclosan coating for small and large intestine resection; the reduction of the risk of surgical site infection during small and large intestine resection; the feasibility of using antibiotic therapy and the validity of combining the latter with systemic antibacterial therapy; and the prospects of developing a biologically active suture material.

Effect of Surgery on Postoperative Levels of the Gut Homeostasis-Regulating Enzyme Intestinal Alkaline Phosphatase.

Intestinal homeostasis is a crucial factor for complication-free short- and long-term postoperative recovery. The brush border enzyme intestinal alkaline phosphatase (IAP) is an important regulator of gut barrier function and intestinal homeostasis and prevents endotoxemia by detoxifying lipopolysaccharides (LPSs). As IAP is predominantly secreted by enterocytes in the duodenum, we hypothesized that pancreaticoduodenectomy (PD) leads to a significantly stronger decrease in IAP than other major abdominal surgery. Pre- and postoperative blood, stool, and intestinal samples were collected from patients undergoing PD, as well as other major surgical procedures without duodenectomy. The samples were analyzed using enzyme histochemistry, the para -nitrophenyl phosphate method for IAP, and the limulus amebocyte lysate assay for LPS. Overall, 88 patients were prospectively enrolled in the study. Fecal IAP activity negatively correlated with serum LPS (r = -0.3603, p = 0.0006). PD led to a significant decline in IAP compared to preoperative baseline levels (p < 0.0001). The decline in IAP correlated with the length of proximal small intestinal resection (r = 0.4271, p = 0.0034). Compared to controls, PD was associated with a much more pronounced reduction in IAP-also after adjusting for surgical trauma (operative time, blood loss; r = 0.4598, p = 0.0086). Simultaneously, PD triggered a clearly more prominent increase in serum LPS compared to controls (p = 0.0001). Increased postoperative LPS was associated with an elongated hospitalization (r = 0.7534, p = 0.0062) and more prominent in pancreatic cancer (p = 0.0009). Based upon the functional roles for IAP, supplementation with exogenous IAP might be a new treatment option to improve short- and long-term outcome after PD.

Altered fecal microbiome and metabolome profiles in rat models of short bowel syndrome.

Short bowel syndrome (SBS) is featured by impaired nutrients and fluids absorption due to massive small intestine resection. Gut dysbiosis has been implicated in SBS, this study aimed to characterize the metagenomic and metabolomic profiles of SBS and identify potential therapeutic targets. Fecal samples from SBS and Sham rats (n = 8 per group) were collected for high-throughput metagenomic sequencing. Fecal metabolomics was measured by untargeted liquid chromatography-mass spectrometry. We found that the species-level α-diversity significantly decreased in SBS rats, accompanied by altered microbiome compositions. The beneficial anaerobes from Firmicutes and Bacteroidetes were depleted while microorganisms from Lactobacillus, Escherichia, Enterococcus, and Streptococcus were enriched in faces from SBS rats. LEfSe analysis identified 17 microbial species and 38 KEGG modules that were remarkably distinct between SBS and Sham rats. In total, 1,577 metabolites with known chemical identity were detected from all samples, among them, 276 metabolites were down-regulated and 224 metabolites were up-regulated in SBS group. The typical signatures of SBS fecal metabolome comprised reduced short-chain fatty acids and products of amino acid metabolism (indole derivatives and p-cresol), as well as altered bile acid spectrum. We revealed 215 robust associations between representative differentially abundant microbial species and metabolites, the species with the same changing trend tended to have a similar correlation with some certain metabolites. The fecal microbiome and metabolome significantly altered in SBS. Our findings may lay the foundation for developing new strategies to facilitate intestinal adaptation in SBS patients.

Persistent hypoxaemia and pulmonary oedema in a horse anaesthetised for emergency exploratory laparotomy

AbstractA 16‐year‐old, 550 kg Connemara gelding was anaesthetised for resection of multiple small intestine strangulating lipomas via ventral midline celiotomy. Severe hypoxaemia, detected throughout the anaesthetic period (lowest PaO2 58 mmHg [7.6 kPa]), was unresponsive to the ventilatory strategies implemented. Flared nostrils and increased respiratory rate were present at recovery from anaesthesia. When the horse was returned to the yard, bilateral foamy nasal discharge and increased respiratory effort and rate were noticed, consistent with pulmonary oedema. The horse received oxygen supplementation and furosemide, which led to complete resolution within 24 hours.

Small bowel segment with Meckel’s diverticulum volvulus related to short mesodiverticular band: a case report

BackgroundMeckel’s diverticulum is a remnant of the omphalomesenteric duct and occurs in only about 2% of people. Mesodiverticular band is the congenital remnant of the vitelline artery and is an even less often occurring phenomenon.Presented caseWe present the case of a 56-year-old Caucasian male who was admitted to the emergency department with a very intense, sudden abdominal pain, without past abdominal surgery history. Contrast enhanced computed tomography showed a possibly ischemic closed loop of the small intestine. Urgent laparotomy was performed, during which bloody content in the peritoneal cavity and torsed loop of the small intestine with Meckel’s diverticulum were found. The bowel loop and Meckel’s diverticulum were ischemic. At the tip of Meckel’s diverticulum there was a broken fibrous band extending to mesentery with pulsating artery. We did segmental resection of small intestine including Meckel’s diverticulum and primary end-to-end anastomosis. The patient had an unremarkable postoperative hospital stay and was discharged home after 5 days.ConclusionIn our case, we describe a patient with the volvulus of a segment of small bowel and Meckel’s diverticulum, which eventually led to small bowel obstruction and ischemia. It was a very rare case that required urgent surgical treatment.

Factors affecting the development of complications in Crohn's disease in patients undergoing intestinal resection.

Surgery is a common form of management for Crohn disease (CD) in the presence of intra-abdominal complications. In this study, we investigated the effect of various factors on the development of postoperative complications in patients who underwent surgery for complicated CD. Patients who underwent surgery between 2011 and 2018 were included in this study. Information on age, sex, presence of extraintestinal findings, operation indications, operation type, and postoperative complications was obtained. Groups with and without postoperative complications were compared according to body mass index, American Society of Anesthesiologists score, comorbidities, smoking status, preoperative drug use, presence of perianal disease, presence of a stoma, synchronous small intestine resection surgery, duration of hospital stay, and preoperative biochemical parameters. A total of 192 patients were included, of which 53.1% were female and 46.9% were male. Patients were indicated for surgery for reasons such as stricture, abscess, fistula, and tumor development. As the surgical method, patients were operated on by open or laparoscopic method (86% and 14%, respectively). Postoperative complications occurred in 30 female and 33 male patients (15.6% and 17.1%, respectively). Patient age, smoking status, steroid use, perianal disease, presence of stoma, and presence of extra intestinal findings were significantly higher in the complicated group. Surgery may be inevitable for CD in the presence of complications. In cases of patient age, smoking, steroid use, perianal disease, stoma opening, and presence of extra intestinal findings, patients with CD who undergo surgery should be followed up closely in terms of the development of complications.

P455 Comparison of two strategies for the management of post-operative recurrence in Crohn’s disease patients with one clinical risk factor: a multicentre IG-IBD study

Abstract Background Prevention of postoperative recurrence (POR) in Crohn’s disease (CD) after ileo-colonic (IC) resection is still a highly debated topic. Prophylactic immunosuppression after surgery is currently recommended in presence of at least one clinical risk factor (RF). Due to drug-related adverse events and the relative high cost of biologics, we aimed to determine whether prevention of POR can be postponed and guided by endoscopy in CD patients with only one RF. Methods A multicentre retrospective study was conducted in 12 IG-IBD Italian centres. CD patients with only one RF for POR, including previous intestinal resection, extensive small intestine resection (&amp;gt;50 cm), fistulising phenotype, history of perianal disease, or active smoking were considered. Patients who performed a colonoscopy between 6 to 12 months after curative IC resection were included. Two groups were formed based on whether immunosuppressive therapy was started immediately after surgery (prophylaxis group) or guided by endoscopy (observation group). Primary endpoints were the rates of any endoscopic recurrence (Rutgeerts ≥i2a) and severe endoscopic recurrence (i4) within 12 months after surgery. Secondary outcomes were clinical recurrence (HBI≥5) rates at 6, 12 and 24 months after surgery. Results A total of 195 patients were enrolled. Out of all, 61 (31.3%) received immunoprophylaxis at a median time of 32 days [IQR 26-55] after surgery (n=14 infliximab, n=37 adalimumab, n=7 azathioprine, n=3 ustekinumab). Baseline patient characteristics are detailed in Table 1. Particularly, risk factors for POR were homogeneously distributed between the 2 groups. Colonoscopy was performed after a median time of 8 months [IQR 6-11]. No differences between immunoprophylaxis and endoscopy-driven approach was found regarding any endoscopic recurrence (36.1% in prophylaxis group vs 45.5% in observation group, p=0.10) and severe endoscopic recurrence (9.8% in prophylaxis group vs 15.7% in observation group, p=0.15). In 32 patients with a second colonoscopy at a median time of 30.5 months [IQR 22-43.75] after surgery, any recurrence and severe recurrence rates were also similar (p=0.55 and p=0.43, respectively). Early clinical recurrence at 6 months was reported in 23.4% of patients on immunoprophylaxis vs 31.5% who were not (p=0.43). Clinical recurrence rates between prophylaxis and observation group were also similar at 12 months (17.9% vs 34.8%, respectively, p=0.09) and at 24 months (17.9% vs 24.1%, respectively, p=0.63). Conclusion In CD patients with only one RF for POR, immediate immunoprophylaxis after curative IC resection does not decrease the rate of early clinical and endoscopic recurrence. Prospective and larger studies are needed to confirm our results.

P074 Interferon-γ promotes antigen processing and presentation pathway in the intestinal epithelium of patients with Crohn’s disease

Abstract Background Interferon-γ (IFN-γ) is a major driver of excessive immune response, leading to intestinal mucosal damage and contributing the pathogenesis of Crohn’s diseases (CD). In contrast to the inflammatory cells and immune system, IFN-γ-induced cellular responses has not been well documented in the intestinal epithelium. The intestinal epithelium consists of multiple cell types and patient-derived intestinal organoid model may be appropriate to evaluate the IFN-γ-induced epithelial cellular responses in patients with CD. Methods To evaluate the IFN-γ-mediated epithelial cellular responses, human small intestinal organoids (enteroids) derived from the controls (n=6) and patients with Crohn’s disease (CD, n=10) were constructed. We focused on the IFN-γ-induced cell death mechanism upregulated in CD enteroids and validated them in surgically resected small intestine in patients with active CD. Results As the concentration of IFN-γ increased in the culture medium, the organoid-forming efficiency decreased steadily, which did not differ between control and CD enteroids. The enteroid viability measured using MTT was estimated to be 83.10 pg/ml for EC50. In control and CD enteroids treated with 100 pg/ml IFN-γ, PANoptosis was the main inflammatory cell death mechanism. Bulk and single-cell RNA sequencing revealed that IFN-γ induced the expression of MHC class II-associated genes, co-inhibitory molecule CD274 (PD-L1), and IDO1 in control and CD enteroids, which may be associated with peripheral tolerance in the absence of exogenous antigens. Gene set enrichment analysis identified an up-regulated antigen processing and presentation pathway with increased expression of MHC class I molecules in IFN-γ-treated CD enteroids compared to IFN-γ-treated control enteroids (normalized enrichment score=2.13, p=0.002, q=0.005). IFN-γ-induced MHC class I pathway could result in T cell-mediated cytotoxicity in CD enteroids. The selective JAK1 inhibitor, upadacitinib, inhibited the IFN-γ-induced PANoptosis and T cell-mediated cytotoxicity in CD enteroids. The expression of HLA-A and B was higher in the inflamed small intestine in patients with CD than those in patients with ischemic enteritis. Conclusion IFN-γ promotes antigen processing and presentation pathway in the intestinal epithelium. In patients with CD, increased expression of MHC class I molecules may induce T cell-mediated cytotoxicity, which could contribute to the development of CD.

Small Intestinal Perforation Caused by Enteric-coated Low-dose Aspirin: A Case Report.

A 77-year-old man presented with abdominal pain for 1 week. He was taking enteric-coated low-dose aspirin (LDA) to prevent secondary cardiovascular events and a proton pump inhibitor (PPI). Computed tomography indicated a small intestinal perforation; thus, small intestine resection was performed. Two months after surgery, he experienced a recurrence of the perforation. Since his repeated perforation was suspected to be due to LDA, LDA was discontinued. He has experienced no further recurrence since then. This is the first case of small intestinal perforation caused by enteric-coated LDA. Enteric-coated LDA may cause small intestinal perforation in patients with severe atherosclerosis under PPI administration.