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

Autor: Barreiro-de Acosta, M, Riestra, S, Calafat, M, Soto, MP, Calvo, M, Rodriguez, ES, Caballol, B, Vela, M, Rivero, M, Munoz, F, de Castro, L, Calvet, X, Garcia-Alonso, FJ, Fornals, AU, Ferreiro-Iglesias, R, Gonzalez-Munoza, C, Chaparro, M, Bujanda, L, Sicilia, B, Alfambra, E, Rodriguez, A, Fernandez, RP, Rodriguez, C, Almela, P, Arguelles, F, Busquets, D, Tamarit-Sebastian, S, Castro, CR, Jimenez, L, Marin-Jimenez, I, Alcaide, N, Fernandez-Salgado, E, Iglesias, A, Ponferrada, A, Pajares, R, Roncero, O, Morales-Alvarado, VJ, Ispizua-Madariaga, N, Sainz, E, Merino, O, Marquez-Mosquera, L, Garcia-Sepulcre, M, Elorza, A, Estrecha, S, Suris, G, Van Domselaar, M, Brotons, A, de Francisco, R, Canete, F, Iglesias, E, Vera, MI, Mesonero, F, Lorente, R, Zabana, Y, Cabriada, JL, Domenech, E, Rodriguez-Lago, I, Registry, ESGFTE
Rok vydání: 2022
Předmět:
Zdroj: JOURNAL OF CROHNS & COLITIS
r-IGTP. Repositorio Institucional de Producción Científica del Instituto de Investigación Germans Trias i Pujol
instname
ISSN: 1873-9946
Popis: 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.
Databáze: OpenAIRE
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