scholarly journals P171 Does microscopic involvement of the surgical margins after ileocececal resection in Crohn’s disease patients predicts early recurrence?

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S223-S223
Author(s):  
M ZEMEL ◽  
E Solo ◽  
J Klausner ◽  
H Tulchinsky
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Medical Treatment ◽  
Disease Recurrence ◽  
Male Gender ◽  
Stapled Anastomosis ◽  
Perianal Disease ◽  
Ileocecal Resection ◽  
Resected Specimen ◽  
Histopathological Evidence

Abstract Background Past research has identified different factors which are associated with post-operative recurrence of Crohn’s disease (CD). However, controversy remained whether the microscopic presence of CD in the margins of the resected specimen increases the risk of recurrence. The main aim of our study was to determine whether microscopic presence of CD in the resected specimen margin in patients who underwent ileocecal resection predicts disease recurrence. The secondary aim was to identify other risk factors for recurrence. Methods We retrospectively evaluated all CD patients who underwent ileocecal resection in our unit between 2000 and 2015. The diagnoses of CD and information regarding the margins’ involvement were retrieved from pathology reports. Recurrence was indicated according to medical records or according to specific phone questionnaire. Demographic and clinical parameters where compared between patients with and without histopathological evidence of CD in the resected margins. Results 202 CD patients were included: 49 patients with histopathological evidence of CD in the resected margins and 153 patients without involvement. The main demographic characteristics were similar. Patients who received preoperative medical treatment had statistically significant higher rate of uninvolved margins (90.8 vs. 77.6%, p = 0.03). Technical aspects including surgical approach, conversion rates to open surgery, and anastomotic methods were similar. Likewise, the post-operative course regarding medical treatment, endoscopic and clinical recurrence, and reoperation rates was also similar. We found a statistically significant shorter time for disease recurrence in laparoscopic surgery (HR 1.6, CI 1.1–2., p = 0.02(, stapled anastomosis (HR 1.7, CI 1.2–2.6, p = 0.01), if stricturoplasty was done in addition to the ileocecal resection (HR 1.7, CI 1.1–2.6, p = 0.02(, and in patients with perianal disease (HR 1.7, CI 1.1–2.6, p = 0.02(. Male gender and conversion from laparoscopic to open surgical technique had increased HR but did not reach statistical significance. Conclusion The presence of microscopic CD at the resection margins was not associated with disease recurrence. We found that male gender, perianal disease, laparoscopic approach, conversion to laparotomy and stapled anastomosis were associated with early disease recurrence. Our results support a conservative approach in the determination of the extent of resection in CD patients having ileocecal resection.

scholarly journals Predictive value of tissue calprotectin for disease recurrence after ileocecal resection in pediatric Crohn's disease

2021 ◽  
Author(s):  
Kristyna Zarubova ◽  
Ondrej Fabian ◽  
Ondrej Hradsky ◽  
Tereza Lerchova ◽  
Filip Mikus ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Predictive Value ◽  
Disease Recurrence ◽  
Ileocecal Resection

Postoperative Management of Crohn’s Disease: What Can We Do to Prevent Recurrence?

2016 ◽  
Vol 2 (11) ◽  
Author(s):  
Adriana Georgiana Olariu ◽  
Liliana Bordeianou
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Disease Recurrence ◽  
Postoperative Recurrence ◽  
Postoperative Management ◽  
Chronic Inflammatory Bowel Disease ◽  
Ileocecal Resection ◽  
Endoscopic Recurrence ◽  
Relapsing Remitting ◽  
Patients Experience

<p>Crohn’s disease (CD) is a chronic inflammatory bowel disease with a relapsing, remitting course.  Approximately one in four CD patients requires surgery within five years of diagnosis. Unfortunately, surgery is rarely curative and up to 70% of CD patients experience endoscopic recurrence and 40% have clinical disease recurrence within 18 months after surgery.</p><p> </p><p>This review is aimed at providing internists and gastroenterologists a foundation for the management of patients who underwent ileocecal resection for CD. We provide an overview of the current definitions of postoperative recurrence and prognostic factors for postoperative CD recurrence. As recent studies raised concerns about the value of these factors, we examine the evidence behind the current risk stratification algorithm and pharmacologic treatment recommendations. Lastly, we discuss future directions for research.</p>

scholarly journals P190 Ileo-caecal Crohn’s Disease; medical or surgical management. Cost and outcomes

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S258-S259
Author(s):  
M Charan ◽  
L Maclaren ◽  
C Bryant ◽  
K Wade ◽  
H Johnson ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Medical Treatment ◽  
Terminal Ileum ◽  
Disease Recurrence ◽  
Outcome Data ◽  
Point Of View ◽  
Endoscopic Recurrence ◽  
Primary Surgery

Abstract Background An ileo-caecectomy is known to be an effective treatment for Crohn’s disease limited to the terminal ileum that can lead to a long term remission. ECCO guidelines recommend that patients with active inflammation should be treated medically. However the LIR!C trial suggested there are QOL benefits and reduced costs to performing primary surgery. Methods We aimed to compare the outcomes of patients treated with primary medical treatment to primary surgery for patients with Crohn’s disease limited to the terminal ileum. We reviewed our database to identify all these patients and analysed outcome data. Results 49 patients were identified: Mean age was 50 yrs (range 22 - 93). 23 were male. Mean length of follow-up was 96 months (range 3 - 404). 1st line treatment was: medical; 33 (67.3%), surgery; 16 (32.6%). Outcomes after medical treatment: 27 of 33 patients failed primary medical treatment, they required surgery at a mean of 38 months (range 1–900) after initiating medical treatment. Colonoscopy after surgery to assess for disease recurrence: Colonoscopic assessment or calprotectin post was undertaken ileo-caecectomy in 4 of 16 patients at a mean of 6.2 months (range 1–10) who underwent primary surgery; and in 25 of 27 patients who underwent surgery following failure of medical treatment. Outcomes after surgery: 4 of 16 patients who had primary surgical treatment had endoscopic recurrence, requiring medical treatment after a mean of 4.4 months (range 0–10). 8 of 27 patients who had surgery post-failure of medical treatment developed disease recurrence, requiring medical treatment after a mean of 40 months (range 7–136) Bile acid malabsorption (BAM): BAM occurred after surgery in 10 of 43 patients. No medically managed patient developed BAM. Conclusion These data suggest that in our population the vast majority of patients with ileo-caecal Crohn’s disease will fail medical treatment and require surgery. 25% of those who undergo surgery will develop BAM (requiring medication), and 40% of those treated surgically will require immunosuppressant treatment in the medium term. These outcomes should be discussed with patients so that they appreciate that ileo-caecectomy is unlikely to lead to long term drug free treatment, and medical treatment is unlikely to lead to the avoidance of surgery. From a health-economics point of view it could be argued there is little point in offering primary medical therapy and ileo-caecectomy should be the initial treatment of choice for patients with limited ileo-caecal Crohn’s disease. Unfortunately endoscopic/calprotectin assessment following primary surgery was often not performed in the majority of patients, and changes in our local practice need to be undertaken to correct this.

Su1916 Complications and Disease Recurrence After Primary Ileocecal Resection in Pediatric Crohn's Disease: A Multicenter Cohort Analysis

2016 ◽  
Vol 150 (4) ◽  
pp. S587
Author(s):  
Kay Diederen ◽  
LIssy de Ridder ◽  
Patrick Van Rheenen ◽  
Victorien Wolters ◽  
Luisa Mearin ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Cohort Analysis ◽  
Disease Recurrence ◽  
Ileocecal Resection ◽  
Multicenter Cohort

scholarly journals DOP62 Morbidity after primary ileocecal resection for Crohn’s disease in the years of biologics: Lesson learned over 631 patients exclusively treated in a tertiary centre

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S101-S102
Author(s):  
M Rottoli ◽  
M Tanzanu ◽  
G Vago ◽  
A Belvedere ◽  
D Parlanti ◽  
...  
Keyword(s):  
Risk Factors ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Medical Treatment ◽  
Univariate Analysis ◽  
Preoperative Assessment ◽  
High Volume ◽  
Ileocecal Resection ◽  
Tertiary Centre ◽  
Major Complications

Abstract Background Several risk factors for morbidity after surgery for Crohn’s disease of the terminal ileum have already been identified. However, the study population is rarely homogeneous, due to high-volume centres receiving patients treated in other hospitals with diverging medical protocols and different thresholds for surgical referral. A study including only patients undergoing homogeneous perioperative treatment in a single referral centre might reduce the selection bias. The aim of this study was to identify the risk factors for minor (Clavien-Dindo ≤2) and major (Clavien-Dindo ≥3) postoperative complications in patients who received medical treatment and surgery in a single centre. Methods Retrospective analysis of ileocecal resections for Crohn’s disease in biological era (2004–2019). Recurrence was excluded. Risk factors for minor and major complications were identified through univariate and multivariable logistic regression analyses. Variables were selected by univariate analysis with p &lt; 0.2 criteria, then a stepwise selection with entry criteria p = 0.05 and stay criteria p = 0.1. Results Of 631 patients included (59.4% male, median age 37 years), 214 (34%) had previous surgery and 152 (24.1%) biologics. Laparoscopy was feasible in 35.9% of cases, 285 patients (45.1%) required surgery on other bowel sites due to multiple locations or fistulae. 281 (44.5%) patients presented with fistulizing disease. Risk factors for 90-day minor complications (22.8%). Risk factors for 90-day major complications (6.8%). Conclusion Risk of minor complications was higher in younger patients, especially after a longer medical treatment. Fistulating disease increases the risks only if the rectum and sigmoid colon are involved. Major complications seem to be related to specific patient’s comorbidities, rather than disease characteristics. Onset of hypertension and neuro-vascular disease, known adverse events of chronic steroid use, should not be underestimated in the preoperative assessment of patients. Poor nutritional status greatly increased the risk of minor and major complications; therefore, any effort should be made towards the nutritional optimisation of Crohn’s patients

Biologics recommendations in the ECCO guidelines on therapeutics in Crohn's disease: medical treatment

2021 ◽  
pp. flgastro-2021-101881
Author(s):  
Danujan Sriranganathan ◽  
Jonathan P Segal ◽  
Mayur Garg
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Medical Treatment ◽  
Medical Management ◽  
Perianal Disease ◽  
Maintenance Of Remission

In 2019, the European Crohn’s and Colitis Organisation released guidelines for the medical management of Crohn’s disease, concerning the induction of remission, the maintenance of remission and the treatment of fistulising perianal disease. This review summarises the key recommendations regarding the use of biologics in these settings.

Risk factors for postoperative complications after surgery in complicated Crohn’s disease

2021 ◽  
pp. 44-52
Author(s):  
A.V. Vardanyan ◽  
M.V. Shapina ◽  
A.V. Poletova ◽  
S.I. Achkasov
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Conservative Treatment ◽  
Postoperative Period ◽  
Right Hemicolectomy ◽  
Male Gender ◽  
Ileocecal Resection ◽  
Short Operative Time ◽  
Stoma Formation ◽  
Complications Rate

Aim: to improve results of the surgical treatment of Crohn’s disease. Patients and Methods: 162 patients were included. 69 (42,6 %) — received preoperative conservative treatment. Ileocecal resection was performed in 148 (91,4 %), in 5 (3,1 %) cases — part of jejunum resection, ileum resection — in 3 (1,8 %) patients and right hemicolectomy — 6 (3,7 %). Stoma formation was in 104 (64,2 %) patients. Complications were registered in 25 (15,4 %) cases. Results: in univariant analysis it was found that young age up to 40 years, male gender and short operative time ( 150 min) are the predictors (р = 0,03, р = 0,03 и р = 0,02, respectively) to noncomplicated postoperative period (reduce risk in 10, 5 и 10 fold, respectively). The absence of conservative treatment before surgery increased the complications’ rate more than 3 times comparing to patients who received therapy (OR 3,2 CI 95 % 0,1–11,45; р = 0,06), but we failed to get significance, that is why multivariant analysis was carried out to see the influence of all clinical factors on non-treated patients. Significance was found in all models. Conclusion: male gender (OR 0,2 CI 95 % 0,01–2,02; р = 0,02), the age younger than 40 (OR 0,1 CI 95 % 0,02–0,9; р = 0,03) and the duration of the operation less than 150 minutes (OR 0,1 CI 95 % 0,01–2,02; р = 0,03) is associated with the reduction of complications in the postoperative period. Preoperative conservative treatment during 3 months allows to decrease the rate of complications to 3,5 times (OR 3,5 CI 95 % 1,2–9,8; р = 0,01) and risk of the stoma formation — to 7 times (χ2 = 7,56; р = 0,006).

Sign in / Sign up

Export Citation Format

Share Document