P0226 Postoperative recurrence after a definitive ostomy in Crohn's disease. A nationwide retrospective series from the Eneida registry

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Abstract Background Although the concept of postoperative recurrence (POR) in Crohn’s disease (CD) has been limited to patients undergoing intestinal resection with anastomosis, some small-sized retrospective series with short follow-up periods suggest that clinical POR may occur in up to 30% of patients with a definitive ostomy. This may explain the lack of recommendations for monitoring and preventive strategies in this clinical setting. Our aim was to assess the risk of POR and current monitoring strategies in this population. Methods Retrospective study from the ENEIDA database of GETECCU. Patients with CD and a permanent ostomy were included. Demographic, clinical characteristics, evolution, and monitoring data were analyzed. Results Overall, 263 patients who underwent permanent ostomy between 1979 and 2023 were included, of whom 70% had an ileostomy and 30% a colostomy with 65% having previous ileal involvement in both groups. Proctectomy had been performed in 57% of them. Medical prevention for POR was started in 38% of patients (44% thiopurines, 43% biologics, and 13% 5ASA). Regarding monitoring strategies in asymptomatic patients, 25% underwent ileoscopy, 43% had radiological examinations and 53% faecal calprotectin measurements. Moreover, 37% underwent radiological examinations and 55% ileoscopy due to the development of symptoms or elevation of biomarkers. After a median follow-up of 142 months (IQR 75-267), 32% developed clinical POR, 16% biological POR, 37% endoscopic POR, 37% radiological POR, and 14% surgical POR. Among those with POR, 37% started medical therapy (9% 5ASA, 24% thiopurines, 65% biologics). The cumulative probability of clinical POR at 3, 5, and 10 years was 16%, 20%, and 28%, respectively. The cumulative probability of surgical POR at 3, 5, and 10 years was 5%, 8%, and 12%, respectively. In the multivariate analysis, risk factor for clinical POR was having colostomy vs. ileostomy (OR 2.05, 95% CI 1.05-3.99; P=0.035). As for complications during follow-up, 40%, 24%, and 18% of patients developed iron-deficiency anemia, vitamin B12 deficiency, or renal insufficiency, respectively. Conclusion More than one third of patients with CD and a permanent ostomy develop POR in the long-term, and 10% requiring a new resection. These findings underscore the need for recommendations on monitoring strategies and preventive approaches n this clinical scenario.

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