Novel Antimesenteric Functional End-to-End Handsewn (Kono-S) Anastomoses for Crohn's Disease: A Report of Surgical Procedure and Short-Term Outcomes

Introduction: Anastomotic surgical recurrence after bowel resection is a major problem in patients with Crohn's disease. The aim of this prospective observational study was to evaluate the efficacy of a novel technique for restoring bowel continuity after resection involving either the small or the large intestine. Methods: The first case was instructed by Dr. Kono at Fujita Health University. The involved bowel segment was divided transversely with a linear stapler. The edges of two stapled lines are then connected to create a supporting column, which prevented surgical recurrence from anastomotic distortion due to mesenteric longitudinal ulcers. Thereafter, an antimesenteric longitudinal enterotomy was performed on each side to create a large-sized handsewn end-to-end anastomosis. Results: Thirty consecutive patients underwent Kono-S anastomoses from December 2009 to August 2013. Neither anastomotic leakage nor surgical recurrence was observed during a median follow-up period of 35 months. Endoscopic surveillance was performed in 18 cases (69.2%) undergoing ileo-colonic or ileo-rectal anastomosis with an average Rutgeert's score of 0.78 (0-3) at a mean of 14.5 months postoperatively. Conclusion: The Kono-S anastomosis for Crohn's disease has been a safe and feasible technique. Long-term outcomes are required to confirm its advantage in preventing surgical recurrence at the anastomosis.

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P587 Adalimumab in pediatric Crohn’s disease: A long-term multi-centre real-world experience

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.715 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S491-S492

Author(s):

S Lawrence ◽

H Huynh ◽

W El-Matary ◽

J DeBruyn ◽

M Carroll ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Combination Therapy ◽

Clinical Remission ◽

Long Term Outcomes ◽

Faecal Calprotectin ◽

Significant Difference ◽

Necrosis Factor

Abstract Background There is a paucity of data regarding long-term outcomes for adalimumab (ADA) in pediatric Crohn’s disease (CD). We describe the long-term effectiveness of ADA, in achieving clinical and biochemical remission in a Canadian multi-centre pediatric CD cohort. Moreover, we report the effects of prior anti-TNF exposure and use of a concomitant immunomodulator (IM) on durability of clinical and biochemical response. The primary outcome was 24-month corticosteroid (CS) free remission. Secondary objectives included biochemical and faecal calprotectin response over the study period. Methods Retrospective review of electronic records of all children aged 3–18 years with CD requiring ADA at 4 centres across Canada (Vancouver, Edmonton, Winnipeg and Calgary) between January 2005 and December 2017. Results One hundred and nine children (68% male; median age 13.07 [IQR 10.6–15.1]) with CD (L1 21.7%, L2 28.3%, L3 50%) were included with a median follow-up of 15.9 months [IQR 7.6–24]. Seventy-four patients (67.9%) were anti-tumour necrosis factor (TNF) naïve. Concomitant IM therapy was used in 51 (46.8%). CS free clinical remission at 24 months was observed in 45/66 (68%). Over time, the median PCDAI, CRP, ESR and faecal calprotectin significantly improved (Table 1). During follow-up, 36 (33%) patients discontinued ADA; 6 (5.5%) had primary non-response, 28 (25.7%) had secondary LOR and 2 (1.8%) had intolerance. At 24 months, clinical remission was achieved more frequently in patients who were Anti-TNF naïve (81% vs. 43.5% p 0.002). There was no significant difference in biochemical or faecal calprotectin outcomes between those who were bio-naive or experienced. There was no significant difference in the time to loss of response between those on monotherapy and combination therapy with an IM and ADA (HR 0.64 [95% CI 0.33–1.26] p0.2). Conclusion This study demonstrates that ADA is effective and durable in pediatric CD. Over 24 months, clinical, biochemical and faecal calprotectin improvement was seen. In our cohort, clinical response to ADA was greater in anti-TNF naïve compared with anti-TNF experienced patients; however,, biochemical and faecal calprotectin outcomes did not differ. ADA response appears durable with no significant difference in patients on monotherapy or combination therapy.

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Long-term outcomes of laparoscopic versus open ileocolic resection for Crohn's disease: Follow-up of a prospective randomized trial

Yearbook of Surgery ◽

10.1016/s0090-3671(09)79339-5 ◽

2009 ◽

Vol 2009 ◽

pp. 255-256

Author(s):

K.I. Bland

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Randomized Trial ◽

Prospective Randomized Trial ◽

Ileocolic Resection ◽

Long Term Outcomes

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Faculty Opinions recommendation of Long-term outcomes of laparoscopic versus open ileocolic resection for Crohn's disease: follow-up of a prospective randomized trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1137840.594925 ◽

2008 ◽

Author(s):

Johan Soderholm

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Randomized Trial ◽

Prospective Randomized Trial ◽

Ileocolic Resection ◽

Long Term Outcomes

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Long-term outcomes of laparoscopic versus open ileocolic resection for Crohn's disease: Follow-up of a prospective randomized trial

Surgery ◽

10.1016/j.surg.2008.06.016 ◽

2008 ◽

Vol 144 (4) ◽

pp. 622-628 ◽

Cited By ~ 92

Author(s):

Luca Stocchi ◽

Jeffrey W. Milsom ◽

Victor W. Fazio

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Randomized Trial ◽

Prospective Randomized Trial ◽

Ileocolic Resection ◽

Long Term Outcomes

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P405 Comparison of long-term outcomes of infliximab vs. adalimumab in 1488 biologic-naive Korean patients with Crohn’s disease

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.534 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S374-S374

Author(s):

Y S Jung ◽

M Han ◽

S Park ◽

J H Cheon

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Population Based ◽

Long Term Outcomes ◽

Population Based Study ◽

Korean Patients ◽

Asian Patients ◽

Significant Difference

Abstract Background Data on the comparative effectiveness of infliximab (IFX) or adalimumab (ADA) in patients with Crohn’s disease (CD) are rare, particularly for Asian patients. We compared the clinically key outcomes (surgery, hospitalisation, and corticosteroid use) of these two drugs in biologic-naive Korean patients with CD. Methods Using National Health Insurance claims, we collected data on patients who were diagnosed with CD and exposed to IFX or ADA between 2010 and 2016. Results We included 1488 new users of biologics (1000 IFX users and 488 ADA users). Over a median follow-up of 2.1 years after starting biological therapy, there were no significant differences in the risk of surgery (ADA vs. IFX; adjusted hazard ratio [aHR], 1.30; 95% confidence interval [CI], 0.86–1.95), hospitalisation (aHR, 1.05; 95% CI, 0.84–1.32), and corticosteroid use (aHR, 0.84; 95% CI, 0.58–1.22) between IFX and ADA users. These results were unchanged even when only patients who used biologics for over 6 months were analysed (aHR [95% CI]; surgery: 1.41 [0.88–2.26], hospitalisation: 1.06 [0.83–1.35], and corticosteroid use: 0.82 [0.56–1.21]). Additionally, these results were stable in patients treated with biological monotherapy or combination therapy with immunomodulators. Conclusion In this nationwide population-based study, there was no significant difference in the long-term effectiveness of IFX and ADA in the real-world setting of biologic-naive Korean patients with CD. In the absence of trials to directly compare IFX and ADA, our study supports that the choice of one of these two biologics may be allowed to be determined by the preference of patients and/or physicians.

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