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Capsule Endoscopy (CE) Is Superior to Magnetic Resonance Enterography(MRE) for the Assessment of Small Bowel Lesions in Crohn's Disease Patients(CD): A Comparative TrialAlvaro Diaz-Gonzalez, Sonia Rodríguez, Cristina Rodriguez de Miguel, Ingrid Ordás,Arantxa Jauregui, Elena Ricart, Anna Ramirez, Marta Gallego, Jordi Rimola, Maria Pellise,Gloria Fernandez-Esparrach, Angels Gines, Oriol Sendino, Josep Llach, Julian Panes,Begoña Gonzalez Suarez

Introduction: Overall, diagnostic yield of CE for the assessment of small bowel lesions inCD is higher than radiologic imaging techniques. However, with regard to MRE, data arescarce and inconclusive. Colon Capsule Endoscopy (CCE) is a new capsule modality withhigher angle view and better image quality compared to conventional small bowel capsule(SBCE). To date, there are no studies comparing CCE to MRE. Objective: To evaluate andto compare diagnostic yield of MRE and CCE in the assessment of small bowel lesions inCD patients. Patients and methods: We included 55 patients (21 men and 34 women) withestablished (n=43) or suspected CD (n=9) and 3 patients with indeterminate colitis. Allpatients underwent initially the MRE to rule out strictures, and subsequently the CCE wasperformed. In 37 patients a CCE was performed and the remaining 18 underwent a conven-tional SBCE. In seven patients with a suspected stricture in the MRE, an Agile PatencyCapsule was performed. Results: Small bowel lesions were found in 46 patients with CEand in 22 patients with MRE (83.6% vs 45.5%, p<0.05). Concordance between presenceor absence of lesions was 58% (32/55 patients). In seven patients with suspected stricturein MRE (ileum wall thickening), Agile Patency capsule was retrieved with no modificationsin 100% of cases. CE detected lesions in proximal and medium small bowel in 16 patientsthat were not detected by MRE (p=0.03). Lesions in the terminal ileum were diagnosed byCE in 46 patients and in 24 patients by MRE (83.6% vs 43.6%, p=0.03). Conclusions:These results indicate that: 1. CE is superior to MRE for the detection of proximal andmedium small bowel lesions in CD. 2. In this study, 100% of patients with a suspectedstricture in MRE could be safely evaluated by CE after a correct expulsion of the AgilePatency Capsule.

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Sexual Function and Body Image Is Similar After Laparoscopic and Open IlealPouch-Anal AnastomosisMie D. Kjær, Stig B. Laursen, Peiman H. Poornoroozy

Introduction Colectomy and an ileal pouch-anal anastomosis (IPAA) may be indicated inpatients with ulcerative colitis (UC) and patients with familial adenomatous polyposis (FAP).Evaluation of the postoperative sexual function is important, as the majority of these patientsare sexually active and in their fertile age. In general, performance of laparoscopic colorectalsurgery seems to be associated with lower morbidity compared to open colorectal surgery.The main objective was to examine whether laparoscopic assisted IPAA is associated withbetter postoperative sexual function, body image and quality of life compared to open IPAA.Methods The study is a retrospective survey study. Patients treated with laparoscopic assistedor open IPAA during October 2008 to March 2012 were included. Evaluation of sexualfunction, body image and quality of life was performed using the female sexual functionindex (FSFI), the international index of erectile function (IIEF), the body image questionnaire(BIQ), and the short inflammatory bowel disease questionnaire (SIBDQ). Results A total of38 patients were treated with laparoscopic assisted IPAA and 34 patients with open IPAA.Response rate was 74% (laparoscopic IPAA (n=28), open IPAA (n=22)). There were nodifferences in age (39 versus 38 yrs.), quality of life (SIBDQ score 53 versus 53), or timeof follow-up (637 versus 803 days). Diagnoses were UC (n=44), FAP (n=4) and others (n=2). In both groups all patients showed scores above the normal cut-off level of the FSFIand IIEF indicating normal sexual function. There were no significant differences in postoper-atively sexual function as evaluated by the IIEF and FSFI between the groups. There wasno difference in postoperative BIQ between patients treated with open or laparoscopic IPAA.There was, however, a tendency towards a lower postoperative self-esteem among womencompared to men (p = 0.07). We also found a tendency towards a better self-reported bodyimage among women undergoing laparoscopic IPAA compared to open IPAA (p = 0.07).Conclusions Although there might be a tendency towards better body image among womentreated with laparoscopic IPAA, the two surgical techniques in general seem equal regardingpostoperative sexual function.

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Earlier Use of Azathioprine in Ulcerative Colitis Does Not Alter SubsequentNeed for Hospitalisation, Biologic Therapy, or ColectomyRuchit Sood, Saqib Ansari, Tanya Clark, Peter J. Hamlin, Alexander C. Ford

Introduction: Azathioprine (AZA) is an established treatment for ulcerative colitis (UC).However, controversy exists regarding its efficacy in inducing and maintaining clinicalremission, particularly with the advent of biologics which, unlike AZA, have been tested inlarge, rigorously designed randomised controlled trials. We studied the effectiveness of AZAas second-line therapy after failure of 5-aminosalicylates (5-ASAs) in a large cohort of UC

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patients, with particular emphasis on whether its earlier use alters the natural history of thedisease course. Methods: All UC patients treated with AZA at our centre were identifiedfrom a prospective electronic database. We excluded individuals who had received eitherinfliximab or ciclosporin as a bridge to AZA. The following demographic data were collected:gender, age at diagnosis, age at AZA commencement, concomitant therapy at AZA commence-ment, and duration of disease prior to AZA commencement. We assessed response to therapyat 4 months and remission at last point of follow-up, using physicians' global assessment,need for hospitalisation, escalation of therapy to a biologic, or colectomy, and serious adverseevents (including infections and malignancies). We examined whether earlier AZA use (within12 months of diagnosis) reduced need for hospitalisation, biologic therapy, or colectomy.Results: In total, 255 patients were included (55% male, mean age at diagnosis 36.4 years).Mean age at commencing AZA was 42.3 years. Mean disease duration prior to AZA commence-ment was 70 months. Concomitant therapy at AZA commencement was oral 5-ASAs in87%, topical 5-ASAs in 22%, and oral prednisolone in 77%. At 4 months, 207 (81%) of255 patients were still on AZA (46 had discontinued due to adverse events and 2 due tonon-response), and 163 (64%) had responded to therapy. There were 165 (65%) patientsstill receiving AZA at last point of follow-up, of whom 153 (60%) were in remission(mean duration of therapy 64.5 months). 26 patients required admission to hospital for anexacerbation during AZA treatment, 20 patients ultimately required biologic therapy, and21 underwent colectomy. Among 90 patients receiving AZA within 12 months of diagnosis,21 (23%) patients experienced one of these three endpoints, compared with 29 (19%) of154 who commenced AZA >12 months after diagnosis (p = 0.40). Serious adverse eventsincluded 6 cases of pancreatitis, 6 cases of cancer (3 non-melanoma skin cancers) and 1case of neutropenic sepsis presenting within 1 month of AZA commencement. Conclusions:AZA is a safe and effective therapy for UC patients who fail 5-ASAs, and should continueto be used prior to instituting biologic therapies. However, earlier use does not seem toalter the natural history of the disease.

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Determining Patient and Disease Related Risk Factors for the Development ofClinical Recurrence Following Ileocolonic Resection for Crohn's DiseaseWithin a Tertiary InstitutionPritesh Morar, Jonathan D. Hodgkinson, Kanyada Koysombat, Samantha Thalayasingam,Omar Faiz, Ailsa L. Hart, Janindra Warusavitarne

BACKGROUND Ileocolonic resection is reserved for patients with moderate to severe Crohn'sdisease (CD) (1). Postoperative clinical recurrence (CR) can occur in up to 26% in the firstyear and 41% within 5 years (2). Predicting the risk of early CR is key in determiningappropriate treatment strategies. Current studies suggest a history of smoking, recurrentsurgery and penetrating disease contribute to early CR (2,3). Our study aims to determinepatient and disease related preoperative risk factors for the development of early CR withina tertiary referral unit METHODS We retrospectively reviewed case notes of 147 subjectswho underwent ileocolonic resection for CD over a six year period (1st January 2005 - 31stDecember 2010) within our institution. All patient (gender, smoking history, family history)and disease (age of disease onset, disease location, disease phenotype and surgical CDhistory) related variables were extracted. CR was defined as an initiation or change in medicaltreatment for recurrent symptoms with endoscopic or radiological evidence of active disease.Time to CR was measured in months after surgery. Univariate analysis was performed usingthe log rank test and multivariate analysis was performed using cox regression analysis.RESULTS One hundred and thirty one subjects had long term follow up data. Fifty twodeveloped CR (39.7%). On univariate analysis, ileocolonic (p=0.053) and recurrent surgery(p = 0.057) were associated with earlier CR (Figure 1). Multivariate analysis demonstratedileocolonic disease (p = 0.013) and recurrent surgery (p = 0.024) are both significantlyassociated with the presence of earlier CR when adjusting for all disease related variables(Table1). CONCLUSIONS Our data suggests the presence of ileocolonic disease and recurrentCD surgery are independent risk factors for the development of earlier CR. Our studyconfirms current evidence of recurrent surgery being associated with earlier CR (4). Thereis wide variation in the literature with the association of disease location as a risk factor forCR (2,3). The suggestion of ileocolonic disease involvement in earlier CR warrants furtheranalysis with prospective studies. REFERENCES 1. Van Assche G et al. The 2nd Europeanevidence-based Consensus on the diagnosis and management of Crohn's disease: Definitionsand diagnosis. J. Crohn's Colitis. 2010 Feb; 4(1):7-27. 2. Buisson A, et al. Review article:the natural history of postoperative Crohn's disease recurrence. Aliment Pharmacol Ther.2012 Mar; 35(6):625-33. 3. De Cruz P, et al. Postoperative recurrent luminal Crohn's disease:a systematic review. Inflamm Bowel Dis. 2012 Apr; 18(4) : 758-77. 4. Ardizzone S, et al.Azathioprine and mesalamine for prevention of relapse after conservative surgery for Crohn'sdisease. Gastroenterology. 2004 Sep; 127(3): 730-40.Patient & Disease Related Variables - Frequency data, univariate & multivariate analysis forthe development of postoperative clinical recurrence

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