P1127Routine exclusive enteral nutrition versus targeted nutritional therapy in patients with Crohn’s disease undergoing ileocolic resection in the biologic era

Abstract Background Several studies demonstrate the benefit of pre-operative exclusive enteral nutrition (EEN) in patients with Crohn’s disease (CD) undergoing bowel resection. Guidelines do not currently recommend pre-operative EEN in all patients,1 but it is standard of care (SOC) in some centres.2 Methods We performed a retrospective observational study comparing independent cohorts from two tertiary IBD centres (UK and CanadaCAN) where pre-operative SOC differs. The UK centre offers EEN to all patients. The Canadian centre offers nutritional support selectively. Consecutive adult patients with CD undergoing elective/urgent ileocolic resection were included. Emergent procedures were excluded. The primary outcome was the 30-day post-operative complication rate. A priori, we estimated 80% power to detect a non-inferiority margin of 13%. Results We included 273 patients undergoing ileocolic resection between 2014 and 2020 (CAN n = 150; UK n = 123). Baseline characteristics are shown in Table 1. UK patients received pre-operative EEN 99, 80.5% or parenteral nutrition PN 16, 13.0% (median duration 59 42-80 days). CAN patients received low residue/normal diet 139, 92.3%, partial EN 1, 0.7% or PN 10, 6.7% (median duration 7 3-19 days). On univariate analysis (UVA), complication rates were higher in CAN (71 47.3% vs 31 25.2%; OR 2.67 1.59-4.48, p 0.001). The pre-specified non-inferiority boundary of 13% was not met (difference 22.1% CI 10.3-33.9%). Differences in complication rates were mainly Clavien Dindo CD grade 1-2 (50 33.3% vs 25 20.3%; 1.96 1.13-3.41, p = 0.02); not CD grade 3 (p = 0.12). On multivariate analysis, laparoscopic approach (OR 0.52 0.30-0.88, p = 0.01) and pre-operative nutrition (OR 0.38 0.22-0.64, p = 0.0003) were associated with fewer complications. There was collinearity between two major variables (site and nutrition) with site explaining more variance. After adjusting for site, only laparoscopy was associated with fewer complications (0.46 0.27-0.78, p = 0.005). The frequency of primary anastomosis formation was higher in CAN (149/150 99.3%) vs 87/123 [70.7%; p = 0.0001). UVA of this subgroup demonstrated a higher rate of post-operative complications in CAN (71/149 47.7% vs 18/87 20.7%; OR 3.49 1.89-6.24, p 0.001). Conclusion A higher rate of complications was observed in CAN. Outcomes were more favourable among those receiving nutritional support or undergoing laparoscopy. Whilst collinearity between site and nutritional provision limited demonstration of an independent effect, the signal toward improved outcomes underscores the importance of considering pre-operative EEN as part of multidisciplinary optimisation for all patients with CD undergoing non-emergent ileocolic resection. References: 1. Svolos V, Gordon H, Lomer MCE, et al. ECCO Consensus on Dietary Management of Inflammatory Bowel Disease. Journal of Crohn’s and Colitis 2025. DOI: 10.1093/ecco-jcc/jjaf122. 2. Meade S, Patel KV, Luber RP, et al. A retrospective cohort study: pre-operative oral enteral nutritional optimisation for Crohnʼs disease in a UK tertiary IBD centre. Alimentary Pharmacology 56(4):646-663. (https://doi.org/10.1111/apt.17055). Conflict of interest: Dr. Meade, Susanna: Speaker fees FalkPharma, Abbvie Conference fees J and J Ad board J and J Kalisky, Itay: Nil Patel, Chirag: No conflict of interest Honap, Sailish: Sailish Honap has served as a speaker, consultant, advisory board member, and/or received travel grants from AbbVie, AlfaSigma, Banook Group, Ferring, Johnson & Johnson, Lilly, Pharmacosmos, Pfizer, and Takeda. O’Hanlon, Dearbhaile: Takeda educational session speaker fees Lomer, Miranda: Grant: Crohn’s and Colitis UK, GSTT charity, NIHR-HTA Personal Fees: Abbvie, Janssen, Mayoly Other: Course Director of low FODMAP courses for dietitians Blitz, Sandra: No conflict of interest Ghuman, Amandeep: No conflict of interest Rosenfeld, Greg: Grant: Research Grants provided by Abbvie, Pfizer, Ferring, Infoway Canada and Crohn’s and Colitis Canada Educational Grants from Celltrion, and Fresenius-Kabi Personal Fees: Speaker and Consultant fees provided by Abbvie, Celltrion, Ferring, Fresnius-Kabi, Takeda, Merck, Pfizer, Amgen, Viatris, Orgenon Leung, Yvette: takeda, pfizer, Janssen, abbvie, eli lily Irving, Peter Miles: Grant: MSD, Pfizer, Takeda, Celltrion, Galapagos Personal Fees: AbbVie, Arena, BMS, Boomerang Medical, Celgene, Celltrion, Falk Pharma, Ferring, Galapagos, Genentech, Gilead, Hospira, Janssen, Lilly, MSD, Pfizer, Pharmacosmos, Prometheus, Roche, Sandoz, Samsung Bioepis, Sapphire Medical, Sandoz, Shire, Takeda, Tillotts, Topivert, VH2, Vifor Pharma, Warner Chilcott Bressler, Brian: Personal Fees: Janssen, Abbvie, Takeda, Pfizer, Alimentiv, Pendopharm, Genentech, Merck, CSL Other: Stock Options: Qu Biologics, Dova Health Intelligence