Long-Term Outcomes of the Excluded Rectum in Crohn's Disease: A Multicenter International Study.

Autor:	Kassim G; Division of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Yzet C; Division of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Nair N; Division of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Debebe A; Division of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Rendon A; Division of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Colombel JF; Division of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Traboulsi C; University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago, IL, USA., Rubin DT; University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago, IL, USA., Maroli A; Department of Biomedical Sciences, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy., Coppola E; Department of Biomedical Sciences, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy., Carvello MM; Department of Biomedical Sciences, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy., Ben David N; Department of Biomedical Sciences, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy., De Lucia F; Department of Biomedical Sciences, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy., Sacchi M; Department of Biomedical Sciences, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy., Danese S; Department of Biomedical Sciences, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy., Spinelli A; Department of Biomedical Sciences, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy., Hirdes MMC; Division of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands., Ten Hove J; Division of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands., Oldenburg B; Division of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands., Cholapranee A; Division of Gastroenterology and Hepatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA., Riter M; Division of Gastroenterology and Hepatology, Weill Cornell Medical College, NY, USA., Lukin D; Jill Roberts Center for IBD, Weill Cornell Medicine, NY, USA., Scherl E; Jill Roberts Center for IBD, Weill Cornell Medicine, NY, USA., Eren E; Inflammatory Bowel Disease Center at NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA., Sultan KS; Division of Gastroenterology and Hepatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA., Axelrad J; Inflammatory Bowel Disease Center at NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA., Sachar DB; Division of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Jazyk:	angličtina
Zdroj:	Inflammatory bowel diseases [Inflamm Bowel Dis] 2023 Mar 01; Vol. 29 (3), pp. 417-422.
DOI:	10.1093/ibd/izac099
Abstrakt:	Background: Many patients with Crohn's disease (CD) require fecal diversion. To understand the long-term outcomes, we performed a multicenter review of the experience with retained excluded rectums. Methods: We reviewed the medical records of all CD patients between 1990 and 2014 who had undergone diversionary surgery with retention of the excluded rectum for at least 6 months and who had at least 2 years of postoperative follow-up. Results: From all the CD patients in the institutions' databases, there were 197 who met all our inclusion criteria. A total of 92 (46.7%) of 197 patients ultimately underwent subsequent proctectomy, while 105 (53.3%) still had retained rectums at time of last follow-up. Among these 105 patients with retained rectums, 50 (47.6%) underwent reanastomosis, while the other 55 (52.4%) retained excluded rectums. Of these 55 patients whose rectums remained excluded, 20 (36.4%) were symptom-free, but the other 35 (63.6%) were symptomatic. Among the 50 patients who had been reconnected, 28 (56%) were symptom-free, while 22(44%) were symptomatic. From our entire cohort of 197 cases, 149 (75.6%) either ultimately lost their rectums or remained symptomatic with retained rectums, while only 28 (14.2%) of 197, and only 4 (5.9%) of 66 with initial perianal disease, were able to achieve reanastomosis without further problems. Four patients developed anorectal dysplasia or cancer. Conclusions: In this multicenter cohort of patients with CD who had fecal diversion, fewer than 15%, and only 6% with perianal disease, achieved reanastomosis without experiencing disease persistence. (© The Author(s) 2022. Published by Oxford University Press on behalf of Crohn’s & Colitis Foundation. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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