P0469Long-term clinical outcomes in patients with ileo-rectal anastomosis and ileal pouch–anal anastomosis

Background Surgery is required in 10-15% of Ulcerative Colitis (UC) patients (pts), mostly represented by ileo-rectal anastomosis (IRA) or ileal pouch-anal anastomosis (IPAA). Data regarding comparisons between UC pts with IRA or IPAA in terms of long-term clinical outcomes are lacking. We aimed to compare the long term clinical course of UC pts with IRA or IPAA, as assessed by UC-related hospitalizations and need of surgery. Secondary endpoint was to compare the same groups of pts in terms of clinical characteristics before and after surgery. Methods In a retrospective study, all UC pts in follow-up with a prior colectomy with IRA or proctocolectomy with IPAA were considered. Inclusion criteria:1)Diagnosis of UC; 2)UC-related surgery with IRA/IPAA; 3)>2 years follow-up. Exclusion criteria: 1)Crohn’s Disease; 2)ostomy; 3)missing data. Data expressed as median [range], difference assessed by X2 test, Student t-test and Mann-Whitney u-test. Results 43 UC pts were enrolled, including 27(63%) with IPAA and 16(37%) with IRA. Age at surgery (32 [10-54] vs 24.5 [11-70];p=0.1) and UC extent (E2: 9 [33%] vs 4 [25%] and E3: 18 [67) vs 12 (75%);p=0.81) were comparable in pts with IPAA and IRA, as also follow-up duration after surgery (years:14 [4-30] vs 16.5 [3-44];p=0.5). During follow up, the frequency of UC-related hospitalizations and surgery was comparable in IPAA and IRA (13 [48%] vs 9 [56%],p=0.47; 3 [11%] vs 5 [31%];p=0.21).Median daily stool discharge was higher in IPAA (7 [3.5-16] vs 5 [1.5-10];p=0.006), while the rates of urgency, rectal bleeding and fecal incontinence were comparable between groups. Aminosalycilates use was more frequent in pts with IRA (oral:11 [41%] vs 12 [75%];p=0.02; local:0 [0%] vs 8 [50%];p=0.001) while antibiotics use in pts with IPAA (16 [60%] vs 3 [19%];p=0.02). No differences were observed between the 2 groups in terms of UC duration before surgery (IPAA: 5 [0-27] vs IRA: 8 [1-23];p=0.07). Before surgery, the frequency of steroid refractoriness, but not of other treatments, was higher in pts with IPAA (13 [48%] vs 2 [13%];p=0.04).The number of visits and of endoscopies/year was also between groups (IPAA vs IRA: 1.8 [0.6-3] vs 1.6 [0.1-2.7];p=0.23, 0.44 [0,17-1.25] vs 0.34 [0.1-1];p=0.5, respectively). At first endoscopy after surgery, active lesions were observed in a comparable proportion of pts with IPAA or IRA (17 [63%] vs 14 [88%];p=0.08). Pouch or rectal cancer occurred in comparable proportion of pts with IPAA and IRA (0 [0%] vs 1 [6%];p=0.11). Conclusion In the tested population, UC patients undergoing IPAA and IRA showed comparable long-term outcomes.Discomfort may be higher in patients with IPAA due to a higher frequency of stool discharge, while pts with IRA show a higher need of topical treatments. References: 1. Al-Rashedy M, et al. A systematic review of outcomes and quality of life afterileorectal anastomosis for ulcerative colitis. World J Gastroenterol. 2023; 29 (2): 183-196. 2. Barnes EL, et al. The Natural History After Ileal Pouch-Anal Anastomosis for Ulcerative Colitis. Am J Gastroenterol. 2024; 119 (4): 689-702. Conflict of interest: Dr. Neri, Benedetto: No conflict of interest Mancone, Roberto: No conflict of interest Distefano, Mattia: No conflict of interest Fiorillo, Mariasofia: No conflict of interest Laluci, Eleonora: No conflict of interest Balice, Raffaele: No conflict of interest Biancone, Livia: No conflict of interest