P167 Ileocecal valve that cannot be intubated during colonoscopy in patients with Crohn’s disease: Is this a sign of poor prognosis?
Durak, M.B.(1);Simsek, C.(2);Inan, B.(1);Yuksel, I.(1,3)*;
(1)Ankara City Hospital, Department of Gastroenterology, Ankara, Turkey;(2)Health Sciences University- Mehmet Akif Inan Training and Research Hospital, Depatment of Gastroenterology, Sanliurfa, Turkey;(3)Ankara Yildirim Beyazit University School of Medicine, Department of Gastroenterology, Ankara, Turkey;
Background
In Crohn's disease (CD) the inability to intubate ileocecal valve during colonoscopy may be correlated with disease prognosis. We aimed to compare the long-term outcomes of CD patients with or without ileocecal valve intubation during colonoscopy to assess its value as a prognostic parameter.
Methods
Data were retrospectively collected in CD with isolated ileal involvement between January 1993 and July 2022. Patients who underwent ileal resection were excluded. Basal characteristics as well as long-term clinical outcomes including steroid dependence, CD-related hospitalization, biological treatment and abdominal surgery were compared between the two groups of patients with intubated and non-intubated ileocecal valve during colonoscopy.
Results
A total of 155 CD patients were included. Median age at disease onset was 35 years and 63.9% was male. Out of 155, 97 (62.5%) were in intubated and 58 (37.5%) were in non-intubated group. The median follow-up of cohort was 3.81 years (1.44-7.63). Non-intubated group was older at diagnosis (39.0 vs 30.5 age; p=0.002) while other baseline characteristics such as sex, smoking status, family history of IBD, disease duration, perianal disease, upper gastrointestinal and extraintestinal involvements were similar. At baseline, serum hemoglobin (12.3 vs. 13.3 mg/dL; p=0.029), albumin (4.1 vs. 4.3 g/dL; p=0.001), CRP (14 vs. 7.8 mg/L; p=0.005) and CDAI score (301 vs. 208; p<0.001) were all statistically significantly higher in the non-intubated group than in the intubated group.
Non-intubated group had more frequent stenosing (41.4% vs. 10.1%) and penetrating (29.3% vs. 5.2%; p<0.001) disease course. On the other hand, intubated group had more inflammatory disease behavior (84.5% vs. 29.3%; p<0.001). Budesonide (37 vs. 13; p=0.043) and methotrexate use (32 vs. 9; p=0.017) was more common the intubated group, while 5-ASA, steroid, and thiopurine use was similar. Non-intubated group had higher rates of steroid dependence (67.2% vs. 46.4%; p=0.012), biologic treatment (89.7% vs. 58.8%; p<0.001), CD-related hospitalization (81% vs. 24.7%; p<0.001), and major abdominal surgery (58.6% vs. 15.5%; p<0.001).
In logistic regression analysis, positive predictors of successful ileum intubation were inflammatory type CD (OR: 14.821), high serum albumin level (OR: 5.919), and older age (OR: 1.069), whereas negative predictors were stenosing (OR: 0.262) and penetrating (OR: 0.247) CD behavior.
Conclusion
In CD patients with isolated ileal involvement, the inability to intubate the ileocecal valve during colonoscopy may indicate a poor prognosis.