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

Abstract

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 analyzed 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 (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 (HR 1.51, 95%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 once biologicals 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.