P143 - EARLY VERSUS DELAYED INITIATION OF POSTOPERATIVE PHARMACOLOGICAL PROPHYLAXIS TO PREVENT SURGICAL RECURRENCE AFTER INTESTINAL RESECTION IN PATIENTS WITH CROHN’S DISEASE
(Room Poster Hall)
19 Jan 18
5:30 PM
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7:00 PM
Tracks:
Defining Optimal Treatment Algorithms
Background: Rates of surgical recurrence after curative intestinal resection for Crohn’s disease are high. It is unclear whether early initiation of postoperative prophylaxis is efficacious in preventing surgical recurrence. Aims: We compared the efficacy of systematic, endoscopy-driven, and symptoms-driven therapy on surgical recurrence. Methods: Data of patients with curative resection and ileocolonic anastomosis for Crohn’s disease from 2006 to 2014 were retrieved from a prospectively maintained database. Patients were categorized according to the timing of initiation of preventive therapy and were compared. Univariate and multivariate proportional hazards Cox regression analyses were performed to determine independent predictive factor for surgical recurrence. Results: Overall, 184 patients were included. Only age at diagnosis≤16 was identified as an independent risk factor for surgical recurrence in overall cohort (p=0.026). In a subgroup of patients with high risk of recurrence (30 in symptoms-driven, 40 in endoscopy-driven and 75 in systematic group), both systematic and endoscopy-driven therapy were found to be able to delay surgical recurrence compared with symptoms-driven therapy (p=0.021, 0.004). On Cox regression analyses, the systematic therapy reduced surgical recurrence significantly compared with symptoms-driven (HR=0.465, P=0.038), but not endoscopy-driven therapy (HR=1.016, P=0.974). In addition, age at diagnosis≤16 was still an independent risk factor for surgical recurrence in this subgroup. Conclusion: In patients with high risk of recurrence, compared with symptoms-driven therapy, both systematic and endoscopy-driven therapy can delay surgical recurrence. Systematic therapy can reduce surgical recurrence, but this benefit was not superior to endoscopy-driven therapy.