Recurrence Rates After Surgery for Crohn’s Disease and Their Implications Regarding Indications for Surgery (As Seen by the Gastroenterologist)

Background and Aims: Vitamin D deficiency has been associated with disease activity in Crohn’s disease (CD). We assessed whether there is a correlation between vitamin D levels and the risk of postoperative recurrence in CD. Methods: CD patients who underwent surgery were identified from a prospectively maintained database at the University of Chicago. The primary endpoint was the correlation of serum 25-hydroxy vitamin D levels measured at 6–12 months after surgery and the proportion of patients in endoscopic remission, defined as a simple endoscopic score for CD of 0. Clinical, biological (C-reactive protein), and histologic recurrences were also studied. Results: Among a total of 89 patients, 17, 46, and 26 patients had vitamin D levels of <15, 15–30, and >30 ng/mL, respectively. Patients with higher vitamin D levels were significantly more likely to be in endoscopic remission compared to those with lower levels (23, 42, and 67% in ascending tertile order; p = 0.028). On multivariate analysis, vitamin D >30 ng/mL (odds ratio [OR] 0.22, 95% confidence interval [CI] 0.07–0.66, p = 0.006) and anti-tumor necrosis factor agent treatment (OR 0.25, 95% CI 0.08–0.83, p = 0.01) were associated with reduced risk of endoscopic recurrence. Rates of clinical, biological, and histologic remission trended to be higher in patients with higher vitamin D levels (p = 0.17, 0.55, 0.062, respectively). Conclusion: In the present study, higher vitamin D level was associated with lower risk of postoperative endoscopic CD recurrence. Further, studies are warranted to assess the role of vitamin D in postoperative CD recurrence.

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Regional Enteritis (Crohn’s Disease): Indications for Surgery and Operative Strategy

Surgical Clinics of North America ◽

10.1016/s0039-6109(16)42928-2 ◽

1983 ◽

Vol 63 (1) ◽

pp. 27-48 ◽

Cited By ~ 17

Author(s):

Victor W. Fazio

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Regional Enteritis ◽

Indications For Surgery ◽

Operative Strategy

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Ligation of the Intersphincteric Fistula Tract and Endorectal Advancement Flap for High Perianal Fistulas in Crohn’s Disease: A Retrospective Cohort Study

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz181 ◽

2019 ◽

Vol 14 (6) ◽

pp. 757-763 ◽

Cited By ~ 4

Author(s):

Elise M van Praag ◽

Merel E Stellingwerf ◽

Jarmila D W van der Bilt ◽

Wilhelmus A Bemelman ◽

Krisztina B Gecse ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Advancement Flap ◽

Fistula Tract ◽

Recurrence Rates ◽

Perianal Fistulas ◽

Radiological Healing ◽

Intersphincteric Fistula ◽

Clinical Healing ◽

Postoperative Incontinence

Abstract Background and Aims Ligation of the intersphincteric fistula tract [LIFT] and advancement flap [AF] procedures are well-established, sphincter-preserving procedures for closure of high perianal fistulas. As surgical fistula closure is not commonly offered in Crohn’s disease patients, long-term data are limited. This study aims to evaluate outcomes after LIFT and AF in Crohn’s high perianal fistulas. Methods All consecutive Crohn’s disease patients ≥18 years old treated with LIFT or AF between January 2007 and February 2018 were included. The primary outcome was clinical healing and secondary outcomes included radiological healing, recurrence, postoperative incontinence and Vaizey Incontinence Score. Results Forty procedures in 37 patients [LIFT: 19, AF: 21, 35.1% male] were included. A non-significant trend was seen towards higher clinical healing percentages after LIFT compared to AF [89.5% vs 60.0%; p = 0.065]. Overall radiological healing rates were lower for both approaches [LIFT 52.6% and AF 47.6%]. Recurrence rates were comparable: 21.1% and 19.0%, respectively. In AF a trend was seen towards higher clinical healing percentages when treated with anti-tumour necrosis factor/immunomodulators [75.0% vs 37.5%; p = 0.104]. Newly developed postoperative incontinence occurred in 15.8% after LIFT and 21.4% after AF. Interestingly, 47.4% of patients had a postoperatively improved Vaizey Score [LIFT: 52.9% and AF: 42.9%]. The mean Vaizey Score decreased from 6.8 [SD 4.8] preoperatively to 5.3 [SD 5.0] postoperatively [p = 0.067]. Conclusions Both LIFT and AF resulted in satisfactory closure rates in Crohn’s high perianal fistulas. However, a discrepancy between clinical and radiological healing rates was found. Furthermore, almost half of the patients benefitted from surgical intervention with respect to continence.

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Experiences with the Kono-S anastomosis in Crohn’s disease of the terminal ileum—a cohort study

Langenbeck s Archives of Surgery ◽

10.1007/s00423-020-01998-6 ◽

2020 ◽

Author(s):

K. Horisberger ◽

D. L. Birrer ◽

A. Rickenbacher ◽

M. Turina

Keyword(s):

Cohort Study ◽

Crohn’S Disease ◽

Postoperative Complications ◽

Crohn's Disease ◽

Terminal Ileum ◽

Ileocecal Resection ◽

Anastomotic Recurrence ◽

Short Term ◽

Recurrence Rates

Abstract Purpose The most frequent long-term complication after ileocecal resection in Crohn’s disease is anastomotic recurrence and subsequent stenosis. Recurrence typically begins at the site of the anastomosis, raising the question of whether the surgical technique of the anastomosis could affect recurrence rates. Kono-S anastomosis is a hand-sewn antimesenteric functional end-to-end anastomosis that offers a wide lumen that is well accessible for endoscopic dilatation. The purpose of our study is to review the rate of postoperative complications almost 2 years after the introduction of this technique. Materials and methods This is a prospective single-center cohort study of all consecutive patients with Crohn’s disease undergoing ileocecal resection. Patients’ characteristics as well as specific data for the surgical procedure and short-term outcome were evaluated. Results Thirty patients were operated for Crohn’s disease of the terminal ileum (n = 24) or anastomotic recurrence (n = 6). Postoperative complications with a Clavien-Dindo Score ≥ IIIb were observed in three patients. One patient showed a hemorrhage and underwent surgical hemostasis. Two patients developed anastomotic leakage; in both cases, ileostomy was created after resection of the anastomosis. The median hospital stay was 9 days (IQR 7–12). A comparison with a historic group of conventionally operated patients of our hospital revealed no differences in short-term results except for the duration of surgery. Conclusion The Kono-S anastomosis is associated with acceptable short-term results, complications, and recurrence rates comparable with the established anastomotic techniques. Longer operation times are observed, but the few published studies concerning long-term recurrence are promising.

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P639 Epidemiology and patient burden of rectovaginal and anovaginal fistulas in patients with Crohn’s disease: A systematic review

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab076.759 ◽

2021 ◽

Vol 15 (Supplement_1) ◽

pp. S573-S574

Author(s):

K Iglay ◽

D Bennett ◽

M Kappelman ◽

S Thai ◽

M Aldridge ◽

...

Keyword(s):

Quality Of Life ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Observational Studies ◽

Risk Of Bias ◽

Recurrence Rates ◽

Eligibility Criteria ◽

Patient Reported ◽

Related Quality

Abstract Background Rectovaginal fistulas (RVF) and anovaginal fistulas (AVF) in Crohn’s disease (CD) are rare, debilitating conditions that present substantial disease and treatment burdens for women. In this systematic literature review (SLR), articles relating to the epidemiology and burden of CD-related RVF and AVF were assessed in order to summarize evidence from observational studies and highlight knowledge gaps. Methods Articles published in the past 10 years in PubMed and Embase that provide data on incidence, prevalence and insight into the patient experience and disease burden of CD-related RVF and AVF (PROSPERO registration number CRD42020177732) were identified. Two trained reviewers used pre-specified eligibility criteria to identify studies for inclusion and evaluate risk of bias using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool for observational studies. Data were extracted for a range of variables, including study type and design, population, outcomes and limitations. Results Of the 582 records identified, 316 full-text articles were assessed, and 16 studies that met a priori eligibility criteria were included (Figure). Three epidemiology studies were identified, with one study estimating the prevalence of RVF to be 2.3% in women with CD. No studies relating to the incidence or prevalence of AVF were identified. Seven of 12 treatment-pattern studies reported that patients had or required additional procedures before and/or after the intervention of interest, demonstrating substantial treatment burden. Of the nine studies that reported healing/success across multiple surgical types, rates ranged from 14.4% to 81.0%. In the seven studies that assessed clinical outcomes, healing rates were in the range 50–75%, with varying estimates dependent on population and intervention. Two studies reported recurrence rates of 13.3–55.8% across multiple surgical interventions. Patient-reported outcomes obtained using standardized measures were reported in only one of the 16 studies and were limited to overall health related quality of life, faecal incontinence-related quality of life and female sexual function index. None of the 16 studies included reported healthcare-resource utilization in this patient population. Conclusion This SLR shows the high disease and treatment burdens of RVF and AVF in patients with CD and identifies multiple evidence gaps in this field. The published literature lacks robust, generalizable data and demonstrates a compelling need for substantial novel research into these rare and debilitating sequelae of CD. Sponsor: Takeda Pharmaceuticals USA, Inc.

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