P84 The management of Crohn’s disease patients post ileo-caecal resection: a multicentre, regional audit

Introduction 70–90% of patients with Crohn’s disease (CD) require intestinal resection.1 Post-operative recurrence (POR) is common with 30% of patients requiring further surgery.2European Crohn’s and Colitis Organisation (ECCO) guidelines suggest identifying patients at risk of recurrence (disease phenotype, smoking, prior resection), the use of imidazole antibiotics following surgery and assessment for recurrence within 1 year. The ECCO guidelines recommend ileocolonoscopy, although alternative modalities can be used. Method A regional, multicentre, retrospective audit was conducted by GRANT, a network of gastroenterology trainees in Northern England. Data collection was performed for CD patients who had an ileocaecal resection between 1/9/16 and 1/9/17. Patients with an end-ileostomy were excluded. Patients were identified using clinical coding and data collection sheets were completed. Results 7 of 9 Hospital Trusts returned data. The number of eligible patients was 38 with a mean age of 41 years. 76% of patients had at least one risk factor rendering them ‘high-risk’ for POR (figure 1). Only 13% of patients received imidazole antibiotics postoperatively and only 29% had an ileocolonoscopy within 12 months. However, 32% had an alternative assessment of POR, with calprotectin being the most popular. An escalation in treatment following assessment was required in 25% of patients. Postoperatively, 40% of patients had no maintenance therapy before POR assessment; 26% continued on the same therapy as preoperatively and 34% had augmented pre-operative therapy. Conclusions The majority of patients in Northern England who have an ileocaecal resection for CD are high risk for recurrence and many patients are not being assessed. Endoscopic POR predates clinical POR3 and, without monitoring, the opportunity to augment therapy and prevent clinical recurrence can be missed. In Northern England less invasive disease monitoring is being used to assess for POR and this audit would suggest that these have a comparable rate of identifying a need to escalate medical therapy. A postoperative CD management bundle is being developed and will be implemented to assess whether this drives improvement. References Canin-Endres J, Salky B, Gattorno F, Edye M. Laparoscopically assisted intestinal resection in 88 patients with Crohn’s disease. Surg Endosc 1999;13:595–599. Michelassi, F., Testa, G., Pomidor, W.J. et al. Adenocarcinoma complicating Crohn’s disease. Dis Colon Rectum36, 654–661 ( 1993) Rutgeerts P, Crohn’s disease recurrence can be prevented after ileal resection Gut 2002;51:152–153