BSPGHAN 2021 Virtual Annual Meeting

27- 29 April 2021

PHENOTYPE FLIP – RISK OF DEVELOPING CROHN’S DISEASE FOLLOWING RESTORATIVE PROCTO- COLECTOMY FOR ULCERATIVE COLITIS

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David Campbell
David Campbell
5 months ago

Thank you both.
This is now a large series and an important step to change opinions. The BSG guidelines still quote for a 7% reallocation of diagnosis (from UC to Crohn’s). You should have seen 5 or 6 by now, but have not.
I think there is more to add to this discussion on how the work up, and the colectomy itself, can reduce that margin lower. Is that something you will consider taking forward?

Alison Campbell
Alison Campbell
5 months ago
Reply to  David Campbell

Thanks.
Regarding the pre-op workup
The median number of pre-colectomy endoscopies performed was 3 (range 1-10). Two patients with an initial biopsy labelled indeterminate colitis, presented with toxic megacolon before their second colonoscopy so only had 1 colonoscopy despite no initial diagnosis of UC. No patients with a diagnosis of indeterminate colitis underwent RPC and IPAA. Patients with the diagnosis of indeterminate colitis on initial histology had a subsequent diagnosis of UC on imaging or histology before surgery. In 15 patients a firm diagnosis of UC on histology was only made after emergency colectomy for sepsis, bleeding, toxic megacolon or inability to tolerate symptoms.

Alison Campbell
Alison Campbell
5 months ago
Reply to  David Campbell

We considered conversion of diagnosis to Crohn’s and pursued this diagnosis aggressively in those who developed: recurrent pouchitis, other Gastrointestinal (GI) symptoms, or other system involvement (e.g. skin, joints). The diagnosis in these cases was pursued with regular pouchoscopy and biopsy and upper GI endoscopy until the diagnosis was confirmed or an alternative diagnosis was made.
One patient who was unable to tolerate symptoms despite maximal medical therapy, but had repeat diagnosis of indeterminate colitis on 5 colonoscopies, had all histology sent to another centre for a second opinion, which confirmed UC. This patient has subsequently been 1 of the 13 patients extensively investigated to ensure no Crohn’s conversion. She has ongoing upper GI symptoms post RPC and IPAA.

David Campbell
David Campbell
5 months ago

Thank you Alison.