Early ileal resection in Crohn's disease is not associated with severe long-term outcomes: The ERIC study.

Autor: Grellier N; Department of Gastroenterology, Poitiers University Hospital, Poitiers, France.; Department of Gastroenterology, CRSA, Sorbonne Université, INSERM, APHP, Hôpital Saint-Antoine, Paris, France., Kirchgesner J; Department of Gastroenterology, CRSA, Sorbonne Université, INSERM, APHP, Hôpital Saint-Antoine, Paris, France., Uzzan M; Department of Gastroenterology, Mondor Hospital, Paris, France., Mclellan P; Department of Gastroenterology, CRSA, Sorbonne Université, INSERM, APHP, Hôpital Saint-Antoine, Paris, France., Stefanescu C; Department of Gastroenterology and Nutrition Beaujon Hospital, Clichy, France.; Department of General and Digestive Surgery, Saint-Antoine Hospital, Paris, France.; Colorectal Surgery Center, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly sur Seine, France.; Paris IBD Center, Groupe Hospitalier Privé Ambroise Pare-Hartmann, Neuilly, France., Lefèvre JH; Department of General and Digestive Surgery, Saint-Antoine Hospital, Paris, France., Treton X; Department of Gastroenterology and Nutrition Beaujon Hospital, Clichy, France.; Department of General and Digestive Surgery, Saint-Antoine Hospital, Paris, France.; Colorectal Surgery Center, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly sur Seine, France.; Paris IBD Center, Groupe Hospitalier Privé Ambroise Pare-Hartmann, Neuilly, France., Panis Y; Colorectal Surgery Center, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly sur Seine, France.; Paris IBD Center, Groupe Hospitalier Privé Ambroise Pare-Hartmann, Neuilly, France., Sokol H; Department of Gastroenterology, CRSA, Sorbonne Université, INSERM, APHP, Hôpital Saint-Antoine, Paris, France., Beaugerie L; Department of Gastroenterology, CRSA, Sorbonne Université, INSERM, APHP, Hôpital Saint-Antoine, Paris, France., Seksik P; Department of Gastroenterology, CRSA, Sorbonne Université, INSERM, APHP, Hôpital Saint-Antoine, Paris, France.
Jazyk: angličtina
Zdroj: Alimentary pharmacology & therapeutics [Aliment Pharmacol Ther] 2024 Nov; Vol. 60 (10), pp. 1388-1397. Date of Electronic Publication: 2024 Sep 05.
DOI: 10.1111/apt.18247
Abstrakt: Background: Early complicated Crohn's disease (CD) may require ileal resection as first-line treatment.
Aim: To evaluate the long-term outcomes of patients who underwent early ileal resection.
Methods: We conducted a retrospective study in two inflammatory bowel diseases (IBD) referral centres, including patients with ileocaecal resection and segmental ileal resection within 5 years of CD diagnosis. Early resection was defined as within 6 months of diagnosis, intermediate resection between 6 months and 2 years, and late resection between 2 and 5 years. The primary outcome was the cumulative risk of a second ileal surgery. Secondary outcomes included the use of postoperative treatments and morphological recurrence after initial surgery (Rutgeerts score ≥i2, or recurrence on imaging).
Results: Among 393 patients who underwent ileal resection within 5 years of diagnosis, 130, 128 and 135, respectively, had early, intermediate and late resection. The cumulative risk of second surgery at 10 years was not significantly different in the early resection group (25.0% [95% CI 17.4-35.2]), than the intermediate (16.8% [95% CI 10.5-26.2]; p = 0.17) or late resection group (22.7% [95% CI 15.1-33.3]; p = 0.83). The early resection group required fewer postoperative treatments than the late resection group with median survivals without treatments of 3.7 and 0.9 years, respectively (p = 0.002). Patients who had early resection had significantly less morphological recurrence than the late resection group (p = 0.02).
Conclusion: Early ileal resection in CD is not associated with a higher risk of a second resection. It may be associated with reduced use of medical treatments and fewer morphological recurrences.
(© 2024 The Author(s). Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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