P0829 ‘Temporary’ faecal diversion in refractory Crohn’s Disease: too good to be true? A retrospective, single centre analysis Free

Refractory Crohn’s disease (CD) is associated with high morbidity and significantly impaired quality of life. Similarly, perianal fistulising disease is a debilitating condition for a subset of CD patients. As the faecal stream is believed to play an important role in disease pathophysiology, a diverting (ileo)stomy, is sometimes considered as a therapeutic option in patients with extensive colitis and/or refractory anal disease. Long-term outcomes of temporary faecal diversion are limited. We aimed to assess the long-term effect of faecal diversion in CD patients with refractory colon and/or perianal disease, and identify factors associated with successful ostomy reversal.

We conducted a single centre, retrospective observational cohort study in a large IBD referral centre. We included all CD patients who underwent an ileostomy as a temporary measure for managing their refractory disease between 2019 and 2023, enabling at least 12 months follow-up.

We evaluated the clinical impact of faecal diversion, and explored the rate of (successful) restoration of transit. Clinical improvement was defined as significant symptomatic improvement, according to physician global assessment. Resolution of perianal disease was defined as the absence of perianal fistula at the time of the multidisciplinary assessment for transit restoration.

A total of 42 patients, with a median age of 31.5 (interquartile range, IQR 24.2–40.9) and median disease duration of 12.4 (IQR 5.8-18.4) years at time of diversion were included. Patients were followed up for a median of 46.5 (IQR 30.2-67.5) months after ileostomy. Indication for faecal diversion was refractory colitis in 26.2% (n=11), and/or severe perianal disease in 73.8% (n=31). Advanced IBD therapy was restarted in 78.6% (n=33) of patients following diversion.

Faecal diversion resulted in clinical improvement in 57.1% of patients (n=24), of whom 70.8% received advanced therapy (n=17/24), and resolution of perianal disease in 35.5% (n=11/31). A total of 14 patients (33.3%), of whom 7 with a perianal phenotype, were proposed for restoration of transit by the multidisciplinary team. Ultimately, in 9/14 patients, including 4 with perianal disease, the ileostomy was reverted with a persistent bowel continuity of 89.9% after 19.0 (IQR 10.7-27.2) months of follow-up.

Temporary faecal diversion in patients with severe refractory Crohn’s colitis and/or anal disease resulted in significant clinical improvement in almost two thirds of patients, but is often a bridge to a permanent stoma as stoma reversal could only be considered in one third of patients. In these selected cases where the transit was restored, persistent bowel continuity was high.