P1120 ‘Early’ surgery for ileocaecal Crohn’s disease: a study of the patient perspective
Authors: Husnoo N , Whitman A , Wyld L , Morgan J , Lobo A , Brown S 
Published: January 2025

Background

Surgery for Crohn’s disease (CD) is considered when medical therapy is unsuccessful. However earlier bowel resection may offer more stable remission for localised luminal ileocaecal disease. The adoption of earlier surgery into practice comes with challenges, reflected by the difficulty in recruiting participants into trials of surgical treatment. We aimed to establish the acceptability of, and potential barriers to, early surgery from a patient perspective through a multicentre qualitative study.

Methods

Patients with ileocaecal CD from 8 centres across the United Kingdom (including both specialist IBD centres and non-specialist hospitals) were recruited, using purposive sampling, to participate in semi-structured interviews. Interviews were audio-recorded and transcribed. Recruitment continued until data saturation was achieved. Data were analysed thematically; 50% of the data were coded independently by two researchers.

Results

Twenty-nine participants were interviewed (14 males, 17 with a previous bowel resection, median time since diagnosis 6 years (8 months – 10 years), median age 34 years (22-71), 4 non-white patients). The themes and subthemes identified are summarised in Table 1. Participants with a previous bowel resection reported that surgery was not offered to them until they had tried several drugs or until disease complications had ensued; they described a poor quality of life prior to their operation. Surgery-naïve patients viewed a bowel resection as a last resort measure. There were many accounts of surgery being framed negatively by clinicians when offering treatment. Only one patient was aware of the benefits of early surgery. However, even participants with a good surgical outcome viewed surgery negatively; patients generally wanted to avoid an operation because of the risk of a stoma and the potential for complications.

Conclusion

This is the first study investigating the gap between the evidence-base and clinical practice around the management of luminal ileocaecal CD. Patients’ views of treatment are influenced by their clinicians’. In our previous study investigating the clinician perspective on early surgery, clinician-participants were proponents of early surgery. This is in contrast with the findings of this study where patients reported being offered a resection late in the pathway. Surgery should be discussed sooner with patients, ideally as part of a multidisciplinary team consultation. It is possible that patients will still prefer medical therapy to surgery. This has implications for the design of future trials comparing surgery to medical therapy for ileocaecal CD – recruitment into randomised trials may remain difficult in the face of strong patient (and/or clinician) preferences.

References

Ponsioen CY, de Groof EJ, Eshuis EJ, Gardenbroek TJ, Bossuyt PMM, Hart A, et al. Laparoscopic ileocaecal resection versus infliximab for terminal ileitis in Crohn’s disease: a randomised controlled, open-label, multicentre trial. Lancet Gastroenterol Hepatol. 2017;2(11):785-92.

Husnoo N, Gana, T, Hague AG, Khan Z, Morgan JL, Wyld L, Brown SR. Is early bowel resection better than medical therapy for ileocolonic Crohn’s disease? A systematic review and meta-analysis. Colorectal Dis. 2023; 25(6): 1090-1101.

Husnoo N, Morgan JL, Wyld L, Brown SR, P230: The challenges of implementing early surgery for terminal ileal Crohn’s disease – a qualitative study of the clinician perspective, British Journal of Surgery, Volume 111, Issue Supplement_2, March 2024, znae046.119,