P0888 Time-trends in the management of postoperative Crohn’s Disease and its impact on long-term surgical recurrence. Data from the ENEIDA registry
Authors: Piñero G S , Nos P , Ricart E , Calafat M , Riestra S , Mesonero F , Iglesias-Flores E , Pascual-Moreno I , Vera I , Martín-Arranz M D , De Castro L , Taxonera C , Rivero M , Guardiola J , Arranz Hernandez L , Arias Garcia L , Varela P , Giordano A , Gisbert J P , Barrio J , Calvet X , Gutiérrez-Casbas A , García-López S , Gargallo-Puyuelo C J , Huguet J M , Moraleja I , Pérez-Calle J L , Bujanda L , Zabana Y , Ramos L , Sierra M , Carpio D , Barreiro-de-Acosta M , Lorente R , Bermejo F , González-Lama Y , Navarro-Llavat M , Márquez L , Mañosa M , Domènech E 
Published: January 2025

Abstract

Background
Anti-TNF availability has been associated with a decrease of first intestinal resections in patients with Crohn’s Disease (CD). However, few studies have evaluated the impact of the availability of biological therapies in the medical management of postoperative CD and its long-term outcomes.
We aimed to assess the time trends in the strategies for the management of CD in the postoperative setting after a first intestinal resection and the rate of second surgeries (surgical postoperative recurrence –sPOR-) through the last three decades.

Methods
Adult patients with CD who underwent a first ileocolic resection with ileocolic anastomosis between 1990 and 2020 and with at least one year of clinical follow-up, were identified from the Spanish ENEIDA registry. Patients in whom ileocolic resection was due to cancer were excluded. Patients were grouped by the date of the first surgery (before biologicals era -BB- 1990-2000; early biological era -EB- 2001-2010; widespread biological era -WB- 2011-2020). Medical prevention for POR was defined as any immunomodulator or biological agent that was started within the first 6 months after the index surgery and maintained for at least 3 months. Treatment for POR was defined as any immunomodulator or biological that was started at least 6 months after index surgery. Surgical POR was defined as a second intestinal resection at least 6 months after the index surgery.

Results
4,890 patients who were followed-up for a median of 125 months (IQR 70-204), were included. Baseline characteristics of each cohort are shown in Table 1.
A significant increase in the proportion of patients starting medical prevention of POR with thiopurines and biologicals was observed over time as well as in the proportion of patients starting treatment with biologicals.
The cumulative incidence of sPOR significantly decreased in both EB and WB cohorts (second surgery-free survival at 3, 5 and 10 years: BB 96%, 92%, 83%; EB 98%, 96%, 90%; WB 98%, 97%, 91%; P=&lt;0.001). In the IPTW propensity model to weight differences for POR risk factors, both biologicals cohorts remained associated with a lower risk of sPOR.

Conclusion
In the last three decades, we observed a significant increase in the use of medical prevention for POR together with a significant increase in using biologicals to treat POR. These changes resulted in a significant decrease in the cumulative incidence of a second intestinal resection in the long-term.