A modern multidisciplinary approach to the treatment of enterocutaneous fistulas in Crohn’s disease patients

Papa, Alfredo; Lopetuso, Loris Riccardo; Minordi, Laura Maria; Veronica, Alessandra Di; Neri, Matteo; Rapaccini, Gianludovico; Gasbarrini, Antonio; Papa, Valerio

doi:10.1080/17474124.2020.1797484

Cited by 8 publications

(5 citation statements)

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“…65 Presurgical nutrition screening should be executed to identify patients with a high risk of malnutrition, such as in patients with enterocutaneous fistula. 66,67 Severe malnutrition is indicated when at least one of the following criteria are met: (1) more than 10% to 15% of unintentional weight loss within 6 months; (2) a body mass index of less than 18.5 kg/m 2 ; and (3) a serum albumin level of less than 30 g/L (without hepatic or renal dysfunction). Because they are influenced by active disease, serum albumin levels should be carefully interpreted.…”

Section: F I G U R Ementioning

confidence: 99%

Perioperative optimization of Crohn's disease

Lin

Chen

et al. 2022

Annals of Gastroent Surgery

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Crohn's disease (CD) is a chronic inflammatory disease mainly affecting the gastrointestinal tract. With the increased availability of modalities in the last two decades, the treatment of CD has advanced remarkably. Although medical treatment is the mainstay of therapy, most patients require surgery during the course of their illness, especially those who experience complications. Nutritional optimization and ERAS implementation are crucial for patients with CD who require surgical intervention to reduce postoperative complications. The increased surgical risk was found to be associated with the use of corticosteroids, but the association of surgical risk with immunomodulators, biologic therapy, such as anti‐TNF mediations, anti‐integrin medications, and anti‐IL 12/23 was low in certainty. Decisions about preoperative medication must be made on an individual case‐dependent basis. Preoperative imaging studies can assist in the planning of appropriate surgical strategies and approaches. However, patients must be informed of any alterations to their treatment. In summary, the management of perioperative medications and surgery‐related decision‐making should be individualized and patient‐centered based on a multidisciplinary approach.

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Section: F I G U R Ementioning

confidence: 99%

Perioperative optimization of Crohn's disease

Lin

Chen

et al. 2022

Annals of Gastroent Surgery

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“…CD patients with severe fistula are often accompanied by loss of digestive fluid, resulting in disturbance of internal environmental balance, secondary infection, and malnutrition. Therefore, the infection should be readily controlled, and adequate nutritional support provided before elective surgery[ 36 , 37 ]. Yzet et al [ 38 ] recently reported successful cases of endoscopic treatment for enteroexternal fistula, which was feasible with short-term effectiveness.…”

Section: Surgical Indications For CDmentioning

confidence: 99%

Timing of individualized surgical intervention in Crohn’s disease

Xia¹,

Gao²,

Wu³

et al. 2022

World J Gastrointest Surg

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Crohn’s disease (CD) is a chronic inflammatory disorder of the gastrointestinal tract with an increasing incidence worldwide. Comprehensive therapy for CD focuses on symptom control and healing the intestinal mucosa to improve the quality of life and prevent complications. Surgical intervention plays a vital role in comprehensive therapy. However, deciding the optimal timing for surgical intervention has long been a focus of controversy. This review provides insights into the timing of surgery for CD and guides clinicians in daily treatment.

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“…2 Collectively known as penetrating CD, these complications often necessitate a combination of antibiotics to manage infection, percutaneous drainage of abscesses, medication for reducing inflammation and symptom management, and nutritional therapy for optimal nourishment. 3 However, in cases where patients experience penetrating complications, surgical intervention is often considered the primary treatment option for addressing lesions in the bowel.…”

Section: Introductionmentioning

confidence: 99%

“…The persistent inflammation associated with CD can result in the development of deep ulcers that penetrate the intestinal wall and surrounding tissues, resulting in complications such as phlegmons, abscesses and fistulas 2 . Collectively known as penetrating CD, these complications often necessitate a combination of antibiotics to manage infection, percutaneous drainage of abscesses, medication for reducing inflammation and symptom management, and nutritional therapy for optimal nourishment 3 . However, in cases where patients experience penetrating complications, surgical intervention is often considered the primary treatment option for addressing lesions in the bowel.…”

Section: Introductionmentioning

confidence: 99%

A nomogram to predict stoma creation in elective surgical resection for penetrating Crohn's disease

Sun,

Cao,

Guo

et al. 2024

ANZ Journal of Surgery

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BackgroundsThe decision to perform a stoma during surgical resection of penetrating Crohn's disease (CD) is a critical consideration. The objective of this study was to identify factors that influence stoma creation and develop a predictive nomogram model to assist surgeons in making optimal surgical decisions.MethodsA retrospective study was conducted at a tertiary center from December 1, 2012, to December 1, 2021, involving consecutive patients with penetrating CD who underwent elective surgical resection. The LASSO regression method was used to select preoperative predictors, and a nomogram was constructed using multivariate logistic regression. The performance of the nomogram was validated in an internal cohort by assessing its discrimination, calibration, and clinical usefulness.ResultsThe study included 405 cases in the training group and 135 cases in the validation group. Nine risk factors for stoma formation were identified, including disease location, fistula resulted from previous anastomosis, absence of preoperative exclusive enteral nutrition support, albumin levels below 35 g/L, C‐reactive protein levels above 10 mg/L, hemoglobin levels below 100 g/L, perianal disease, internal fistula, and surgical approach. These risk factors were selected using the LASSO regression method, and a nomogram was developed based on them. The area under the curve and the coefficient of determination (R2) of the nomogram were 0.821 and 0.394, respectively. And the nomogram demonstrated good performance in the validation cohort.ConclusionsThe nomogram exhibited good predictive ability for stoma formation during elective surgical resection for penetrating CD, which can assist surgeons in making informed clinical decisions.

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A modern multidisciplinary approach to the treatment of enterocutaneous fistulas in Crohn’s disease patients

Cited by 8 publications

References 50 publications

Perioperative optimization of Crohn's disease

Perioperative optimization of Crohn's disease

Timing of individualized surgical intervention in Crohn’s disease

A nomogram to predict stoma creation in elective surgical resection for penetrating Crohn's disease

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