P0214Lesions at the ileal inlet are most predictive of Crohn’s disease postoperative recurrence

Abstract Background Ileocecal resection with an ileocolic anastomosis is the most common surgical procedure for Crohn’s disease (CD).1 Today’s leading surgical techniques, the (Kono-S) side-to-side and side-to-end anastomosis, have introduced new anatomical locations.2 Furthermore, lesions at the ileal inlet, corresponding to the critical diameter proximal to the anastomotic line, have been suggested to be associated with a higher risk of postoperative recurrence.1-3 The aim of our study was to evaluate the risk of postoperative recurrence according to the anatomical location of the lesions. Methods We conducted a retrospective analysis of 85 patients with CD after ileocecal resection (47% male, median age 33 years). All patients underwent a video-recorded ileocolonoscopy within 14 months of resection, which were centrally scored by eight expert endoscopists with the updated Rutgeerts score (URS) and a granular score per anatomical location (anastomotic line, ileal blind loop, ileal body, ileal inlet and neo-terminal ileum). The development of clinical postoperative recurrence (cPOR) was assessed. cPOR was defined as presence of CD-related symptoms combined with at least one of the following: C-reactive protein 5 mg/L, faecal calprotectin 250 µg/g, endoscopic recurrence (Rutgeerts score of ≥ i2b), or radiological signs of neoterminal ileitis. Patients that underwent treatment optimization based on this index ileocolonoscopy were excluded. We used Cox regression models to assess the association between granular endoscopic scores and cPOR. Models were adjusted for either the dichotomised or categorised URS and for postoperative prophylactic therapy. Results The majority of patients (84%) underwent an ileocecal resection with isoperistaltic side-to-side anastomosis. The median (interquartile range, IQR) time from ileocolonic resection to first postoperative ileocolonoscopy was 6.21 (5.88-7.00) months. During a median follow-up of 6.15 (4.91-8.07) years, 47% of patients developed cPOR. Analysis of the granular endoscopic scoring revealed that presence of lesions at the ileal inlet was associated with an increased risk of cPOR. Statistically significant association were observed for the deep aphthoid lesions hazard ratio 1.96 (95% confidence interval 1.02-3.77), p = 0.045, punctiform lesions HR 1.96 (1.02-3.77), p = 0.045, deep ulcerations HR 3.23 (1.33-7.83), p = 0.01 and large superficial ulcerations HR 2.89 (1.12-7.39), p = 0.029. In contrast, no significant associations were observed with lesions in other locations. (Table 1) Conclusion The significant association between ileal inlet lesions and cPOR underscores the importance of incorporating new anatomical locations into endoscopic scoring systems, supporting the broader application of the URS. References: 1. Rivière P, Pekow J, Hammoudi N, et al. Comparison of the Risk of Crohn’s Disease Postoperative Recurrence Between Modified Rutgeerts Score i2a and i2b Categories: An Individual Patient Data Meta-analysis. Journal of Crohn’s and Colitis. 2023;17(2):269-276. doi:10.1093/ecco-jcc/jjac137 2. Rivière P, Bislenghi G, Vermeire S, et al. Postoperative Crohn’s Disease Recurrence: Time to Adapt Endoscopic Recurrence Scores to the Leading Surgical Techniques. Clin Gastroenterol Hepatol. 2022;20(6):1201-1204. doi:10.1016/j.cgh.2022.02.025 3. Hammoudi N, Auzolle C, Tran Minh ML, et al. Postoperative Endoscopic Recurrence on the Neoterminal Ileum But Not on the Anastomosis Is Mainly Driving Long-Term Outcomes in Crohn’s Disease. Am J Gastroenterol. 2020;115(7):1084-1093. doi:10.14309/ajg.0000000000000638 Conflict of interest: Mr. Simonič, Jože: No conflict of interest Simonič, Polona: No conflict of interest Tyrode, Gaëlle: No conflict of interest Daperno, Marco: Personal Fees: Takeda, Johnson & Johnson, GILEAD, Roche, Pfizer, Abbvie, Ferring, Chiesi, Alfasigma, Celltrion, Sanofi Other: Clinical trials: Takeda, Janssen, Roche Domènech Moral, Eugeni: Personal Fees: I have served as a speaker, or has received research or education funding or advisory fees from AbbVie, Adacyte Therapeutics, Biogen, Celltrion, Gilead, Janssen, Kern Pharma, MSD, Pfizer, Roche, Samsung, Takeda, Tillots. Other: I have served as a speaker, or has received research or education funding or advisory fees from AbbVie, Adacyte Therapeutics, Alfasigma/Galapagos Biogen, Celltrion, Ferring, Gilead, GoodGut, Imidomics, Janssen, Kern Pharma, Lilly, MSD, Pfizer, Roche, Takeda, Tillots. Laharie, David: Personal Fees: Board, consulting and lecture fees from Abbvie, Alfasigma, Amgen, Biocon, Celltrion, Ferring, Fresenius-Kabi, Johnson & Johnson, Lilly, Medac, MSD, Pfizer, Sandoz, Takeda. Mañosa Ciria, Miriam: Personal Fees: AbbVie, Adacyte, Lilly, Janssen, MSD, Pfizer, Kern, Ferring, Faes and Tillots Reinisch, Walter: Personal Fees: WR has served as a speaker for AbbVie, Alfasigma, Celltrion, Ferring, JNJ, Galapagos Medice, Lilly, MSD, Roche, Pfizer, Sobi, Takeda, as a consultant for AbbVie, Agomab, Alfasigma, Alvotech, Amgen, Anaptys Bio, AOP Orphan, Boehringer Ingelheim, Bristol Myers Squibb, Calyx, Celltrion, Eli Lilly, Galapagos, Gilead, Index Pharma, Janssen, Medahead, Merck, Microbiotica, Pfizer, Sanofi, Teva, Takeda as an advisory board member for AbbVie, Alfasigma, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celltrion, Galapagos, JNJ, Pfizer, Teva and has received research funding from AbbVie, JNJ, Sandoz, Sanofi, Takeda. Guedelha Sabino, João: Speaker’s fees: Lilly, Pfizer, Abbvie, Ferring, Falk, Takeda, Janssen, Fresenius, and Galapagos. Consultancy fees: Takeda, Pfizer, Janssen, Ferring, Fresenius, Abbvie, Galapagos, Celltrion, Pharmacosmos, and Pharmanovia. Research support: Galapagos, Viatris, and Eurogenerics. JS is supported by a Senior Clinical researcher grant from the Research foundation – Flanders. Vermeire, Séverine: Grant: AbbVie, Pfizer, Takeda, J&J, Galapagos Personal Fees: AbbVie - AbolerIS Pharma - AgomAb - Alimentiv - Arena Pharmaceuticals - AstraZeneca - Avaxia- BMS - Boehringer Ingelheim - Celgene - CVasThera - Dr Falk Pharma - Ferring - Galapagos - Genentech-Roche - Gilead - GSK - Hospira - Imidomics - Janssen - J&J - Lilly - Materia Prima - MiroBio - Morphic - MrMHealth - Mundipharma - MSD - Pfizer - Prodigest - Progenity - Promakhos Therapeutics - Prometheus - Robarts Clinical Trials - Second Genome - Shire - Surrozen - Takeda - Theravance - Tillots Pharma AG - Zealand Pharma - Other: AbbVie, MSD, Takeda, Ferring, Genentech/Roche, Shire, Pfizer Inc, Galapagos, Mundipharma, Verstockt, Bram: Research support from AbbVie, Biora Therapeutics, Celltrion, Landos, Pfizer, Sanofi, Sossei Heptares/Nxera and Takeda. Speaker’s fees from Abbvie, Agomab, Alfasigma, Biogen, Bristol Myers Squibb, Celltrion, Eli Lily, Falk, Ferring, Galapagos, Materia Prima, Johnson and Johnson, Pfizer, Sandoz, Takeda, Tillots Pharma, Truvion and Viatris. Consultancy fees from Abbvie, Alfasigma, Alimentiv, Anaptys Bio, Applied Strategic, Astrazeneca, Atheneum, BenevolentAI, Biora Therapeutics, Boxer Capital, Bristol Myers Squibb, Domain Therapeutics, Eli Lily, Galapagos, Guidepont, Landos, Merck, Mirador Therapeutics, Mylan, Nxera, Inotrem, Ipsos, Johnson and Johnson, Pfizer, Sandoz, Sanofi, Santa Ana Bio, Sapphire Therapeutics, Sosei Heptares, Takeda, Tillots Pharma and Viatris. Stock options Vagustim and Thethis Pharma. Riviere, Pauline: Personal Fees: Abbvie, Celltrion, Janssen Non-financial Support: Celltrion Ferrante, Marc: Research grants from AbbVie, EG Pharma, Celltrion, Janssen, Pfizer, Takeda and Viatris Consultancy fees from AbbVie, AgomAb Therapeutics, Boehringer Ingelheim, Celgene, Celltrion, Eli Lilly, Janssen-Cilag, MRM Health, Merck Sharp and Dohme, Pfizer, Takeda and ThermoFisher Speakers’ fees from AbbVie, Biogen, Boehringer Ingelheim, Dr Falk Pharma, Ferring, Janssen-Cilag, Merck Sharp and Dohme, Pfizer, Takeda, Truvion Healthcare and Viatris