S1714 The Modified Rutgeerts Score Predicts Clinical Outcomes After Primary Ileocecal Resection in Crohn’s Disease

Introduction: The Rutgeerts Score is used to assess recurrence in Crohn’s disease (CD) following ileocecal resection (ICR). Limited data exist relating clinical outcomes to the modified Rutgeerts Score (mRS), which differentiates isolated anastomotic lesions (i2a) from more extensive lesions of the neoterminal ileum (i2b). We aim to evaluate factors associated with index colonoscopy mRS and 12-month outcomes stratified by the mRS in CD patients after first-time ICR. Methods: We conducted a retrospective cohort study identifying patients who underwent primary ICR and had their first post-operative colonoscopy report containing a mRS. Patients were stratified based on mRS and compared by demographics, disease characteristics, and outcomes 6-12 months post-index colonoscopy. A Harvey Bradshaw Index >4, elevated C-reactive protein or fecal calprotectin, and imaging with active intestinal inflammation were considered symptomatic, biochemical, and imaging recurrences, respectively. At subsequent endoscopy, mRS i2b – i4 was considered endoscopic recurrence for patients with a prior mRS of i0 – i2a or persistent endoscopic activity for patients with a prior mRS of i2b – i4. Chi Square and Fisher Exact tests were used to compare categorical variables of interest and associations of continuous variables were examined via T-tests or Mann-Whitney U tests. Results: 138 patients were identified meeting inclusion criteria, 96 with a mRS of i0 – i2a and 42 with a mRS of i2b – i4. Patients with a mRS of i2b – i4 were more likely to be above the age of 40 at time of CD diagnosis, had an older age at surgery, were more likely to have an end-to-side anastomosis, and had a longer interval between ICR and their first post-operative colonoscopy compared mRS i0 – i2a patients. Among those with relevant follow up, i2b – i4 patients had higher rates of symptomatic (P < 0.01) and biochemical recurrence (P < 0.01) at 6-12 months after index colonoscopy, and there were numerically higher rates of imaging and endoscopic activity (P = NS). Conclusion: The mRS is strongly associated with outcomes in CD after ICR. Patients with an older age at surgery or over 40 years of age at CD diagnosis may benefit from closer post-operative follow up, and end-to-side anastomoses may carry a higher risk of recurrence. After index colonoscopy, patients with a mRS i2b-i4 should have more proactive surveillance for disease activity. Further prospective studies are needed to validate these observations.