Management and Long-term Outcomes of Crohn's Disease Complicated with Enterocutaneous Fistula: ECUFIT Study from GETECCU.

Autor: Barreiro-de Acosta M; Gastroenterology Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain., Riestra S; Gastroenterology Department, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain., Calafat M; Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas CIBERehd, Madrid, Spain., Soto MP; Gastroenterology Department, Hospital Universitario Reina Sofía, Córdoba, Spain., Calvo M; Gastroenterology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Spain., Sánchez Rodríguez E; Gastroenterology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain., Caballol B; Gastroenterology Department, Hospital Clinic, Barcelona, Spain., Vela M; Gastroenterology Department, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain., Rivero M; Gastroenterology Department, Hospital Universitario Marqués de Valdecilla and IDIVAL, Santander, Spain., Muñoz F; Gastroenterology Department, Hospital Universitario de Salamanca, Salamanca, Spain., de Castro L; Gastroenterology Department, Hospital Álvaro Cunqueiro, Vigo, Spain., Calvet X; Gastroenterology Department, Corporació Parc Taulí, Sabadell, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas CIBERehd, Madrid, Spain., García-Alonso FJ; Gastroenterology Department, Hospital Universitario Río Hortega, Valladolid, Spain., Utrilla Fornals A; Gastroenterology Department, Hospital General San Jorge, Huesca, Spain., Ferreiro-Iglesias R; Gastroenterology Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain., González-Muñoza C; Gastroenterology Department, Hospital Santa Creu i Sant Pau, Barcelona, Spain., Chaparro M; Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa IIS-IP, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas CIBERehd, Madrid, Spain., Bujanda L; Gastroenterology Department, Biodonostia Health Research Institute, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas [CIBERehd], and Universidad del País Vasco [UPV/EHU], San Sebastián, Spain., Sicilia B; Gastroenterology Department, Hospital Universitario de Burgos, Burgos, Spain., Alfambra E; Gastroenterology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain., Rodríguez A; Gastroenterology Department, Hospital General Universitario de Alicante, Alicante, Spain., Pérez Fernández R; Gastroenterology Department, Complejo Asistencial Universitario de León, León, Spain., Rodríguez C; Gastroenterology Department, Complejo Hospitalario de Navarra, Pamplona, Spain., Almela P; Gastroenterology Department, Hospital General Universitari de Castelló, Castelló, Spain., Argüelles F; Gastroenterology Department, Hospital Universitario Virgen Macarena, Sevilla, Spain., Busquets D; Gastroenterology Department, Hospital Universitari Girona Dr. Josep Trueta, Girona, Spain., Tamarit-Sebastián S; Gastroenterology Department, Hospital General de Tomelloso, Tomelloso, Spain., Reygosa Castro C; Gastroenterology Department, Complejo Hospitalario Universitario de Canarias, San Cristóbal de La Laguna, Spain., Jiménez L; Gastroenterology Department, Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain., Marín-Jiménez I; Gastroenterology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain., Alcaide N; Gastroenterology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain., Fernández-Salgado E; Gastroenterology Department, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain., Iglesias Á; Gastroenterology Department, Complexo Hospitalario Universitario de Ourense, Ourense, Spain., Ponferrada Á; Gastroenterology Department, Hospital Universitario Infanta Leonor, Madrid, Spain., Pajares R; Gastroenterology Department, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Spain., Roncero Ó; Gastroenterology Department, Hospital General La Mancha Centro, Alcázar de San Juan, Spain., Morales-Alvarado VJ; Gastroenterology Department, Hospital General de Granollers, Granollers, Spain., Ispízua-Madariaga N; Gastroenterology Department, Hospital Universitario de Basurto, Bilbao, Spain., Sáinz E; Gastroenterology Department, Xarxa Assistencial Universitària de Manresa, Manresa, Spain., Merino O; Gastroenterology Department, Hospital Universitario de Cruces, Barakaldo, Spain., Márquez-Mosquera L; Gastroenterology Department, Hospital Parc de Mar, Barcelona, Spain., García-Sepulcre M; Gastroenterology Department, Hospital General Universitario de Elche, Elche, Spain., Elorza A; Gastroenterology Department, Hospital Universitario de Galdakao, Biocruces Bizkaia Health Research Institute, Galdakao, Spain., Estrecha S; Gastroenterology Department, Hospital Universitario Araba, Vitoria, Spain., Surís G; Gastroenterology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain., Van Domselaar M; Gastroenterology Department, Hospital Universitario de Torrejón, Torrejón de Ardoz, Spain., Brotons A; Gastroenterology Department, Hospital Vega Baja, Orihuela, Spain., de Francisco R; Gastroenterology Department, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain., Cañete F; Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas CIBERehd, Madrid, Spain., Iglesias E; Gastroenterology Department, Hospital Universitario Reina Sofía, Córdoba, Spain., Vera MI; Gastroenterology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Spain., Mesonero F; Gastroenterology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain., Lorente R; Gastroenterology Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain., Zabana Y; Gastroenterology Department, Hospital Universitari Mútua Terrassa, Terrassa, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas CIBERehd, Madrid, Spain., Cabriada JL; Gastroenterology Department, Hospital Universitario de Galdakao, Biocruces Bizkaia Health Research Institute, Galdakao, Spain., Domènech E; Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas CIBERehd, Madrid, Spain., Rodríguez-Lago I; Gastroenterology Department, Hospital Universitario de Galdakao, Biocruces Bizkaia Health Research Institute, Galdakao, Spain.
Jazyk: angličtina
Zdroj: Journal of Crohn's & colitis [J Crohns Colitis] 2022 Aug 04; Vol. 16 (7), pp. 1049-1058.
DOI: 10.1093/ecco-jcc/jjac016
Abstrakt: Background and Aims: Crohn's disease [CD] can develop penetrating complications at any time during the disease course. Enterocutaneous fistulae [ECF] are disease-related complications with an important impact on quality of life. Our aim was to describe the outcomes of this complication, including its medical and/or surgical management and their temporal trends. The primary endpoint was fistula closure, defined as the absence of drainage, with no new abscess or surgery, over the preceding 6 months.
Methods: Clinical information from all adult patients with CD and at least one ECF-excluding perianal fistulae-were identified from the prospectively-maintained ENEIDA registry. All additional information regarding treatment for this complication was retrospectively reviewed.
Results: A total of 301 ECF in 286 patients [January 1970-September 2020] were analysed out of 30 088 records. These lesions were mostly located in the ileum [67%] and they had a median of one external opening [range 1-10]. After a median follow-up of 146 months (interquartile range [IQR], 69-233), 69% of patients underwent surgery. Fistula closure was achieved in 84%, mostly after surgery, and fistula recurrence was uncommon [13%]. Spontaneous and low-output fistulae were associated with higher closure rates (hazard ratio [HR] 1.51, 95% confidence interval [CI] 1.17-1.93, p = 0.001, and HR 1.49, 95% CI 1.07-2.06, p = 0.03, respectively); this was obtained more frequently with medical therapy since biologics have been available.
Conclusions: ECF complicating CD are rare but entail a high burden of medical and surgical resources. Closure rates are high, usually after surgery, and fistula recurrence is uncommon. A significant proportion of patients receiving medical therapy can achieve fistula closure.
(© The Author(s) 2022. Published by Oxford University Press on behalf of European Crohn’s and Colitis Organisation. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
Databáze: MEDLINE
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