Prospective cohort study of appendicectomy for treatment of therapy-refractory ulcerative colitis

Introduction Appendicectomy may reduce relapses and need for medication in patients with ulcerative colitis, but long-term prospective data are lacking. This study aimed to analyse the effect of appendicectomy in patients with refractory ulcerative colitis. Methods In this prospective multicentre cohort series, all consecutive patients with refractory ulcerative colitis referred for proctocolectomy between November 2012 and June 2015 were counselled to undergo laparoscopic appendicectomy instead. The primary endpoint was clinical response (reduction of at least 3 points in the partial Mayo score) at 12 months and long-term follow-up. Secondary endpoints included endoscopic remission (endoscopic Mayo score of 1 or less), failure (colectomy or start of experimental medication), and changes in Inflammatory Bowel Disease Questionnaire (IBDQ) (range 32-224), EQ-5D (TM) and EORTC-QLQ-C30-QL scores. Results A total of 28 patients (13 women; median age 40 center dot 5 years) underwent appendicectomy. The mean baseline IBDQ score was 127 center dot 0, the EQ-5D (TM) score was 0 center dot 65, and the EORTC-QLQ-C30-QL score was 41 center dot 1. At 12 months, 13 patients had a clinical response, five were in endoscopic remission, and nine required a colectomy (6 patients) or started new experimental medical therapy (3). IBDQ, EQ-5D (TM) and EORTC-QLQ-C30-QL scores improved to 167 center dot 1 (P < 0 center dot 001), 0 center dot 80 (P = 0 center dot 003) and 61 center dot 0 (P < 0 center dot 001) respectively. After a median of 3 center dot 7 (range 2 center dot 3-5 center dot 2) years, a further four patients required a colectomy (2) or new experimental medical therapy (2). Thirteen patients had a clinical response and seven were in endoscopic remission. The improvement in IBDQ, EQ-5D (TM) and the EORTC-QLQ-C30-QL scores remained stable over time. Conclusion Appendicectomy resulted in a clinical response in nearly half of patients with refractory ulcerative colitis and a substantial proportion were in endoscopic remission. Elective appendicectomy should be considered before proctocolectomy in patients with therapy-refractory ulcerative colitis.