P0537 Prognostic significance of anastomotic lesions in post-operative Crohn’s disease
Authors: Del Gaudio A , Cuccia G , Privitera G , Parisio L , Coppola G , Laterza L , Lopetuso L R , Carbone L , Papa A , Cammarota G , Gasbarrini A , Scaldaferri F , Pugliese D 
Published: January 2025

Background

Endoscopic evaluation (assessed with the Rutgeerts score, RS) offers prognostic information in the postoperative management of Crohn’s disease (CD). The significance of anastomotic lesions (AL) remains unclear. Two scores have been introduced: the POCER index1 (PI), including circumferential extent and depth of anastomotic ulcers, and the UEDA et al score2 (US), classifying 4 categories of lesions at the anastomosis and peri-anastomosis site. This study aims to evaluate the predictive value of PI and the US in a real- life cohort.

Methods

We conducted a retrospective study including CD patients undergoing ileo-colonic resection. All patients underwent first endoscopic evaluation within 6-12 months to assess endoscopic recurrence (ER), measured with RS, PI and US. ER was defined as RS ≥ 2, PI ≥ 2 or US ≥ intermediate. Clinical recurrence (CR) was assessed at 18-24 months using the HBI. A second endoscopy at 18-24 months was available for a subgroup of patients.

Results

We included 177 patients, 75% of them with no previous history of surgery. All patients had underwent prophylactic therapy with biologics. At 6-12 months, ER was observed in 91 (51%), 35 (20%) and 51 (28%) of patients, according to RS, PI and US, respectively. CR was observed in 34 patients (18.6%). Among 98 pts (55%) with a second endoscopy, ER was present in 45 pts (45%). Looking the predictive value for CR, a RS ≥2 showed an AUROC of 0.74 (sensitivity 82.7%, specificity 56.9%); PI ≥2 an AUROC of 0.613 (sensitivity 31%, specificity 82.5%) and US ≥ intermediate an AUROC of 0.668 (sensitivity 50%, specificity 74.6%). About ER, a RS ≥2 showed an AUROC of 0.77 (sensitivity 70.9%, specificity 79.07%), a PI≥2 with an AUROC of 0.65 (sensitivity 38.18%, specificity 93.02%) and US an AUROC of 0.74 (sensitivity 49.06%, specificity 93.03%). We performed a subgroup analysis among 108 patients with exclusively AL. For CR, the RS&gt;=2 showed an AUROC of 0.67 (sensitivity 58%, specificity 74%). A PI &gt;=2 predicted CR with an AUROC of 0.66 (sensitivity of 25%, specificity of 92%), while the US with an AUROC of 0.63 (sensitivity of 16%, specificity of 93.4%). Regarding ER, RS&gt;=2 showed an AUROC of 0.667 (sensitivity 45%, specificity 89%), PI an AUROC of 0.63 (sensitivity 20%, specificity 97%) and the US&gt;= intermediate an AUROC of 0.65 (sensitivity 16%, specificity 100%).

Conclusion

Grading the anastomotic lesions with specific scores seems to improve the prognostic value of the early endoscopic assessment after resection surgery.

References

1)De Cruz P, Hamilton AL, Burrell KJ, Gorelik A, Liew D, Kamm MA. Endoscopic Prediction of Crohn’s Disease Postoperative Recurrence. Inflamm Bowel Dis. 2022 May 4;28(5):680-688. doi: 10.1093/ibd/izab134. PMID: 34231852.2)

2)Ueda T, Koyama F, Sugita A, Ikeuchi H, Futami K, Fukushima K, Nezu R, Iijima H, Mizushima T, Itabashi M, Watanabe K, Hata K, Shinagawa T, Matsuoka K, Takenaka K, Sasaki M, Nagayama M, Yamamoto H, Shinozaki M, Fujiya M, Kato J, Ueno Y, Tanaka S, Okita Y, Hashimoto Y, Kobayashi T, Koganei K, Uchino M, Fujii H, Suzuki Y, Hisamatsu T. Endoscopic Lesions of Postoperative Anastomotic Area in Patients With Crohn’s Disease in the Biologic Era: A Japanese Multi-Centre Nationwide Cohort Study. J Crohns Colitis. 2023 Dec 30;17(12):1968-1979. doi: 10.1093/ecco-jcc/jjad116. PMID: 37450892.