Background

70% of patients with Crohn’s disease (CD) require intestinal resection.¹ Post-operative recurrence (POR) is common with 70% of patients requiring further surgery in the pre-biologic era.² 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 12 months. The ECCO guidelines recommend ileocolonoscopy, although alternative modalities can be used. The Rutgeerts score predicts POR and is recommended to establish the need for preventative treatment.³ The aim of this study was to undertake a region-wide audit of practice with regards to post-operative CD in the Northern region.

Methods

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

Seven of 9 Hospital Trusts returned data. The number of eligible patients was 38 with a mean age of 41 years. Seventy-six per cent (29/38) patients had at least one risk factor rendering them ‘high-risk’ for POR (Figure 1). Only 13% (5/38) of patients received imidazole antibiotics postoperatively and only 29% (11/38) had an ileocolonoscopy within 12 months. However, 32% (12/38) had an alternative assessment of POR, with calprotectin being the most popular. An escalation in treatment following assessment was required in 25% (9/38) of patients. Postoperatively, 40% (15/38) of patients had no maintenance therapy before POR assessment; 26% (10/38) continued on the same therapy as preoperatively and34% (13/38) had augmented pre-operative therapy.

Conclusion

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 POR [4] 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 maintenance therapy. A postoperative CD management bundle is being developed and will be implemented to assess whether this drives improvement.

中文翻译：

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P561回盲肠切除术后克罗恩病（CD）患者的管理：英格兰北部的多中心区域审核

背景

克罗恩病（CD）的患者中有70％需要进行肠切除。¹术后复发（POR）常见于70％在生物学前时代需要进一步手术的患者。² ECCO指南建议确定有复发风险的患者（疾病表型，吸烟，事先切除），手术后使用咪唑抗生素并评估12个月内的复发。尽管可以使用其他方法，但ECCO指南建议使用回肠结肠镜检查。Rutgeerts评分可预测POR，建议建立预防性治疗的需求。³这项研究的目的是对北部地区的术后CD进行地区范围的实践审核。

方法

格兰特是英格兰北部肠胃病学受训人员网络，对地区进行了多中心回顾性审核。对在1/9/16到1/9/17之间进行回盲切除的CD患者进行数据收集。回肠造口术的患者被排除在外。使用临床编码识别患者，并完成数据收集表。

结果

9家医院信托基金中有7家返回了数据。合格患者的数量为38名，平均年龄为41岁。76％（29/38）的患者具有至少一种危险因素，使其成为POR的“高风险”（图1）。术后仅13％（5/38）的患者接受了咪唑抗生素治疗，仅29％（11/38）的患者在12个月内接受了回肠结肠镜检查。但是，有32％（12/38）对POR进行了替代评估，其中钙卫蛋白是最受欢迎的。25％（9/38）的患者需要评估后进行治疗升级。术后，有40％（15/38）的患者在进行POR评估前未进行任何维持治疗。26％（10/38）继续接受与术前相同的治疗，而34％（13/38）接受了术前增强的治疗。

结论

英格兰北部大部分接受回肠盲肠切除术的患者复发风险很高，许多患者尚未接受评估。内镜POR早于临床POR [4]，并且在没有监测的情况下，可能会错过扩大治疗和预防临床复发的机会。在英格兰北部，正在使用侵入性较小的疾病监测方法来评估POR，这项审计表明，这些方法在确定需要升级维持治疗方面的比率相当。术后CD管理包正在开发中，将用于评估这是否会促进改善。