P2583 - Definitions of Post-Operative Recurrence in Crohn's Disease After End-Ileostomy: A Systematic Review

Tesfaye Yadete, MD¹, Katherine Falloon, MD², Neil Nero, ¹, Suha Abushamma, MD^1
1Cleveland Clinic, Cleveland, OH; ²Cleveland Clinic Foundation, Shaker Heights, OH

Introduction: Inflammatory bowel disease (IBD), encompassing ulcerative colitis (UC) and Crohn's disease (CD), is marked by chronic intestinal inflammation with periods of remission and relapse. Despite advancements in therapy, many IBD patients require surgery. One-third of CD patients need a second surgery, often leading to a permanent end-ileostomy (EI). While UC patients with EI are often 'cured,' CD patients face a risk of recurrence even after EI. Current literature variably defines post-EI recurrence as endoscopic, clinical, surgical, or histological, indicating a need for uniform definitions. Our systematic review aims to synthesize data on post-EI recurrence in IBD patients to improve management strategies.

Methods: We conducted a comprehensive literature search, including studies with confirmed IBD diagnosis, patients aged 18 or older, and published in English. We used a random-effects model to compute pooled recurrence rates and 95% confidence intervals (CI) for clinical, surgical, endoscopic, and imaging recurrence rates, assessing heterogeneity using the inconsistency index (I²).

Results: Data from 1882 CD patients across 27 studies showed that 25% (n=471) experienced recurrence post-EI, with a median time to recurrence of 2-6.8 years. Recurrence was diagnosed clinically in 324 patients (15 studies), endoscopically in 56 patients (4 studies), by imaging in 63 patients (5 studies), and surgically in 269 patients (22 studies). The pooled rate for symptomatic recurrence was 27.8% (95% CI: 23-32.6, I² = 85%). Surgical recurrence was 18.1% (95% CI: 13.1-23.1, I² = 87%), imaging recurrence was 28.2% (95% CI: 12.7-43.8, I² = 96.65%), and endoscopic recurrence was 20.1% (95% CI: 7.4-32.7, I² = 86%).

Analysis of post-EI treatment included biologics (38.8%, 95% CI: 20-57.5, I² = 80.5%), immunomodulators (30.1%, 95% CI: 9-50, I² = 91.5%), steroids (49.6%, 95% CI: 35.4-63.7, I² = 62.5%), and 5-ASAs (40.4%, 95% CI: 30.6-50.2, I² = 0%).

Discussion: Our analysis highlights significant heterogeneity in definitions of post-EI recurrence and treatment strategies. Future studies should establish uniform definitions and criteria to improve comparability and guide effective treatments. Standardizing these aspects is crucial for better managing post-EI recurrences in CD patients.



Disclosures:


Tesfaye Yadete, MD¹, Katherine Falloon, MD², Neil Nero, ¹, Suha Abushamma, MD¹. P2583 - Definitions of Post-Operative Recurrence in Crohn's Disease After End-Ileostomy: A Systematic Review, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.