P230: The challenges of implementing early surgery for terminal ileal Crohn’s disease – a qualitative study of the clinician perspective

Abstract Background Recent evidence suggests that “early” bowel resection may offer more stable remission in terminal ileal (TI) Crohn’s disease compared to medical therapy. Surgery is still often considered late in the treatment pathway. The aims of this study were to understand how clinicians make decisions about treatment for TI Crohn's and to explore their views on the role of surgery. Methods Semi-structured interviews with clinicians across the UK, with an interest in inflammatory bowel disease (IBD), were undertaken using videoconferencing (February to November 2022). Inductive thematic analysis was performed and 10% of the data were double-coded. Data saturation was confirmed before stopping recruitment. Results Participants included 9 consultant surgeons, 7 consultant gastroenterologists and 7 specialist nurses (n=23) from secondary care and tertiary referral centres. Five key themes were identified: approach to management and decision-making, opinions on medical therapy, opinions on surgery, approach to information-giving, and patients’ preferences from a clinician perspective. Symptoms, disease phenotype, patient choice and the influence of the IBD multidisciplinary team were frequently discussed factors that guide management. Trial of multiple drugs before offering surgery was commonly described. A lack of IBD surgeons and long waiting lists for surgical clinics and theatre were cited as barriers to timely surgery. Patients' fear of surgery was thought to be driven by the risk of a stoma. Conclusion This study highlights key barriers to early surgery for TI disease. Early discussion of surgery may allow patients to make an informed choice. Organisational barriers should be considered when designing local services.