Recurrence rates after strictureplasty for small bowel Crohn's disease remain high in the era of biologics
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| Natura: | Artículo Open Access |
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Wiley
2024
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| author | A. Nasasra T. E. M. Morrison A. Luberto M. Carvello K. J. Williams J. Davies A. Spinelli A. M. Mehta J. H. Warusavitarne |
| author_facet | A. Nasasra T. E. M. Morrison A. Luberto M. Carvello K. J. Williams J. Davies A. Spinelli A. M. Mehta J. H. Warusavitarne A. Nasasra T. E. M. Morrison A. Luberto M. Carvello K. J. Williams J. Davies A. Spinelli A. M. Mehta J. H. Warusavitarne |
| collection | Wiley Open Access |
| contents | Recurrence rates after strictureplasty for small bowel Crohn's disease remain high in the era of biologics A. Nasasra T. E. M. Morrison A. Luberto M. Carvello K. J. Williams J. Davies A. Spinelli A. M. Mehta J. H. Warusavitarne Colorectal Disease AbstractAimDespite advancements in therapeutic options for Crohn's disease (CD), strictureplasty is a mainstay bowel‐preserving technique for small bowel CD. We sought to audit international practice across three high‐volume centres since the widespread use of biologic medication.MethodsA retrospective audit was performed for all strictureplasties undertaken for small bowel CD, over a 15‐year period (2006–2021), in three high‐volume centres in the United Kingdom and Italy. Primary endpoints were clinical recurrence and reoperation for recurrence.ResultsIn all, 123 patients were included; 58% were men, 25% smoked and 60% had previous abdominal surgery for CD. Median age was 40 years (interquartile range 30–52 years), mean body mass index 22 (15–31) and median disease duration 138 months (81–255 months). 42% had been treated with biologics preoperatively. In total 338 strictureplasties were performed in 123 patients, with a median of two per patient (interquartile range 1–3). Complications occurred in 35%, with 8% scoring Clavien–Dindo Grade 3. There were no Grade 4/5 complications. Postoperative biologic treatment was administered to 84/123 patients (68.3%). Median follow‐up was 54 months. 41/123 patients (33.3%) developed clinical recurrence. Reoperation for recurrent stricturing was performed in 26/123 patients (21%). Clinical recurrence and reoperation rates were significantly higher in patients who continued to smoke after their index surgery.ConclusionStrictureplasty remains a safe and effective surgical treatment for small bowel CD. Recurrence and reoperation rates remain high, regardless of postoperative biologic therapy. Smoking significantly increases the risk of recurrence. 10.1111/codi.17224 http://onlinelibrary.wiley.com/termsAndConditions#vor |
| doi_str_mv | 10.1111/codi.17224 |
| format | Artículo Open Access |
| id | wiley_oa_10_1111_codi_17224 |
| institution | Wiley Open Access |
| license_str_mv | http://onlinelibrary.wiley.com/termsAndConditions#vor |
| publishDate | 2024 |
| publisher | Wiley |
| record_format | wiley_oa |
| spellingShingle | Recurrence rates after strictureplasty for small bowel Crohn's disease remain high in the era of biologics A. Nasasra T. E. M. Morrison A. Luberto M. Carvello K. J. Williams J. Davies A. Spinelli A. M. Mehta J. H. Warusavitarne Colorectal Disease Recurrence rates after strictureplasty for small bowel Crohn's disease remain high in the era of biologics A. Nasasra T. E. M. Morrison A. Luberto M. Carvello K. J. Williams J. Davies A. Spinelli A. M. Mehta J. H. Warusavitarne Colorectal Disease AbstractAimDespite advancements in therapeutic options for Crohn's disease (CD), strictureplasty is a mainstay bowel‐preserving technique for small bowel CD. We sought to audit international practice across three high‐volume centres since the widespread use of biologic medication.MethodsA retrospective audit was performed for all strictureplasties undertaken for small bowel CD, over a 15‐year period (2006–2021), in three high‐volume centres in the United Kingdom and Italy. Primary endpoints were clinical recurrence and reoperation for recurrence.ResultsIn all, 123 patients were included; 58% were men, 25% smoked and 60% had previous abdominal surgery for CD. Median age was 40 years (interquartile range 30–52 years), mean body mass index 22 (15–31) and median disease duration 138 months (81–255 months). 42% had been treated with biologics preoperatively. In total 338 strictureplasties were performed in 123 patients, with a median of two per patient (interquartile range 1–3). Complications occurred in 35%, with 8% scoring Clavien–Dindo Grade 3. There were no Grade 4/5 complications. Postoperative biologic treatment was administered to 84/123 patients (68.3%). Median follow‐up was 54 months. 41/123 patients (33.3%) developed clinical recurrence. Reoperation for recurrent stricturing was performed in 26/123 patients (21%). Clinical recurrence and reoperation rates were significantly higher in patients who continued to smoke after their index surgery.ConclusionStrictureplasty remains a safe and effective surgical treatment for small bowel CD. Recurrence and reoperation rates remain high, regardless of postoperative biologic therapy. Smoking significantly increases the risk of recurrence. 10.1111/codi.17224 http://onlinelibrary.wiley.com/termsAndConditions#vor |
| title | Recurrence rates after strictureplasty for small bowel Crohn's disease remain high in the era of biologics |
| topic | Colorectal Disease |
| url | https://onlinelibrary.wiley.com/doi/10.1111/codi.17224 |