New York University Langone Medical Center New York, NY, United States
Terry Li, MD1, Jordan Axelrad, MD, MPH2, Benjamin Click, MD, MS3, Michael Sachs, PhD4, Salam P. Bachour, MS5 1New York University Langone Medical Center, New York, NY; 2New York University School of Medicine, New York, NY; 3Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH; 4Karolinska Institute, Solna, Stockholms Lan, Sweden; 5Cleveland Clinic Lerner College of Medicine, Cleveland, OH
Introduction: While ileocecal resection (ICR) often leads to remission of Crohn’s disease (CD), most patients will relapse. Evidence-based guidelines suggest biologic prophylaxis to prevent post-operative recurrence (POR) in high-risk patients and endoscopy within 6-12 months of surgery to assess for POR. Post-operative monitoring intervals and biomarker/cross-sectional imaging use have not been protocolized, leading to diversity in management. We aimed to describe the surveillance approach for CD patients after ICR and determine the association with POR.
Methods: This was a retrospective chart review of CD patients who underwent ICR with ≥1 year of follow-up at an academic medical center. We grouped patients into high- (HR) and low-risk (LR) for POR per guidelines and compared baseline data, medication use, and surveillance approach. We then stratified patients by colonoscopy within 1 year, labs within 1 year, or imaging within 1 year to compare POR rates. Biomarker, radiographic, and endoscopic POR were defined as high CRP/fecal calprotectin (FC), inflammation on CT/MRE, and Rutgeerts ≥ i2, respectively.
Results: Of 154 patients, 142 were HR. Median follow-up time was 32 months (m). 9 (75%) of LR and 104 (73%) of HR patients had colonoscopies within 12m of surgery. 7 (58%) of LR and 60 (42%) of HR patients had another colonoscopy between 12-24m. CRP was assessed in >70% of LR and HR between both 6-12m and 12-24m. FC was done in 33% of LR and 16% of HR between 6-12m and in 17% of LR and 18% of HR between 12-24m. Of those who received biologics, prophylactic treatment was initiated in 3 (43%) of LR and 86 (67%) of HR, median time to start was 5 weeks. Endoscopic POR rates were similar between those with biomarkers within 1 year vs without (p=0.99), imaging within 1 year vs without (p=0.17), and colonoscopy within 1 year vs without (p=0.53). Of patients who had endoscopic POR, 10 (59%) of those with colonoscopy within 1 year of surgery went into remission on ensuing scopes, compared to 0 of those who did not have colonoscopy within 1 year of surgery (p=0.32).
Discussion: Despite guidelines, over one-quarter of patients did not undergo endoscopic monitoring for POR within 1 year of ICR. Biomarker and imaging use varies. Multiple modes of surveillance within 1 year were not associated with reduced endoscopic POR, yet it may be associated with subsequent remission as it likely altered management. Future studies should establish a surveillance protocol to maximize relapse detection and maintain remission.
Figure: a) % of patients receiving surveillance colonoscopy in indicated intervals, separated by low- and high-risk b) % of patients receiving surveillance CRP in indicated intervals, separated by low- and high-risk c) % of patients receiving fecal calprotectin in indicated intervals, separated by low- and high-risk
Legend: - purple bar indicates low-risk patients - yellow bar indicates high-risk patients
Terry Li indicated no relevant financial relationships.
Benjamin Click indicated no relevant financial relationships.
Michael Sachs indicated no relevant financial relationships.
Salam Bachour indicated no relevant financial relationships.
Terry Li, MD1, Jordan Axelrad, MD, MPH2, Benjamin Click, MD, MS3, Michael Sachs, PhD4, Salam P. Bachour, MS5. P2694 - Surveillance Rates and Modalities in Post-Op Crohn's Disease, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.