P201 - Are We Officially Saying Goodbye To The J-Pouch? Retrospective Analysis Of Biologic Therapy And Surgical Trends In Inflammatory Bowel Disease

Purpose/Background: Inflammatory bowel disease (IBD) affects over 2 million individuals in the United States, often leading to reduced quality of life, recurrent hospitalizations, and immunosuppressive therapy. The introduction of biologics has transformed disease management, improved outcomes, and altered the natural history of both ulcerative colitis (UC) and Crohn’s disease (CD). Since widespread adoption of advanced biologics after 2014, national data suggest declining rates of bowel resection and restorative proctocolectomy with ileal pouch–anal anastomosis (IPAA, or “J-pouch”). This study evaluates the impact of biologic therapies on surgical rates and timing of operative intervention in IBD patients over the past two decades.

Methods/Interventions: A retrospective analysis was conducted using the TriNetX de-identified administrative database. Adult patients (18–90 years) with UC or CD who received biologics between November 2004–2024 were identified and divided into two cohorts: Cohort 1 (2004–2014) and Cohort 2 (2014–2024). Patients undergoing gastrointestinal surgery after biologic initiation were included. Outcomes assessed included index age of operation, subsequent surgery rates, and procedure-specific risk within five years of starting biologics (J-pouch, colectomy, subtotal colectomy, stricturoplasty). Propensity score matching (age, gender, race, comorbidities) was used to reduce confounding factors. The analysis compared each cohort to determine overall patient outcomes using risk difference, risk ratio, and odds ratio, and applied t-test statistics to assess differences between the two cohorts.

Results/Outcomes: A total of 23,532 IBD patients met inclusion criteria: 3,974 with UC, 8,763 with CD, and 10,795 who underwent colectomy. Among UC patients, J-pouch creation substantially declined from 90 patients (2.26%) in Cohort 1 to 28 patients (0.50%) in Cohort 2, with patients in Cohort 1 being 3.22 times more likely to undergo surgery (p < 0.05). The mean age at pouch creation was lower in Cohort 1 compared with Cohort 2 (42.3 vs. 46.8 years, p< 0.05). In CD patients, stricturoplasty rates decreased from 41 (0.47%) in Cohort 1 to 21 (0.23%) in Cohort 2, with patients in Cohort 1 2.05 times more likely to receive the procedure (p < 0.05); mean age at operation was similar between cohorts (39.5 vs. 40.1 years). For colectomy, 783 (7.41%) patients in Cohort 1 underwent the procedure compared with 465 (4.39%) in Cohort 2, reflecting a 41% relative reduction, with patients in Cohort 1 1.69 times more likely to undergo colectomy (p < 0.05). Subtotal colectomy rates demonstrated a comparable downward trend. Across all procedure types, surgical rates were consistently lower in the later cohort.

Conclusion/Discussion: Biologic therapy significantly reduced the need for surgical intervention in IBD patients, with marked declines in J-pouch creation for UC, stricturoplasty for CD, and total abdominal colectomy across both diseases. As operative volumes decline and the timing of surgery is delayed, training paradigms must adapt to ensure future colorectal surgeons maintain proficiency in managing complex IBD cases despite their decreasing frequency. Moreover, these significant findings support an association between biologic therapy and decreased operative burden in IBD patients.