OP18 Long-term outcome after first intestinal resection in paediatric-onset Crohn's disease: A population-based study

Boualit, Médina; Salleron, Julia; Turck, Dominique; Mathurin, Philippe; Jl, Dupas; Lerebours, Éric; Duhamel, Alain; Merle, V.; Cortot, A.; Colombel, J.-F.; Peyrin-Biroulet, L; Gower‐Rousseau, Corinne

doi:10.1016/s1873-9946(12)60019-1

Cited by 7 publications

(13 citation statements)

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“…Additionally, patients undergoing resection within 1 year of symptom onset have demonstrated a delay in recurrence of disease (30% by 8 years v 50% by 4 years) 18. This conclusion is supported by the findings of Griffiths et al 21 who demonstrated a reduced recurrence rate in patients undergoing surgery within a year of diagnosis.…”

Section: Discussionmentioning

confidence: 79%

“…These figures should, however, be interpreted in the long-term context; rates of further surgery at 10 years of 29% to 54% have been reported 7 18…”

Section: Discussionmentioning

confidence: 95%

“…A short-term increase in height velocity after surgery for Crohn's disease in adolescence is well recognised 19 24. Interestingly, epidemiological data suggests a growth advantage of early surgery; with a recently published cohort of patients demonstrating better catch-up growth in patients operated on within 3 years of diagnosis 18. However, in long-term follow-up, surgery is not associated with greater improvements in height than medical therapy 20…”

Section: Discussionmentioning

confidence: 99%

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Surgery for children with Crohn's disease: indications, complications and outcome

Blackburn

Wiskin

Barnes

et al. 2014

Archives of Disease in Childhood

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Section: Discussionmentioning

confidence: 79%

“…These figures should, however, be interpreted in the long-term context; rates of further surgery at 10 years of 29% to 54% have been reported 7 18…”

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

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Surgery for children with Crohn's disease: indications, complications and outcome

Blackburn

Wiskin

Barnes

et al. 2014

Archives of Disease in Childhood

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“…Crohn's disease (CD) is a chronic relapsing inflammatory disorder of the alimentary tract with a continuously increasing incidence in the pediatric population [1][2][3][4][5]. Compared to adults, childhood-onset CD typically shows a more active disease pattern and greater need for immunosuppressant therapy [4].…”

mentioning

confidence: 99%

“…Histological activity may develop at the site of the anastomosis as soon as after a week of bowel resection [11]. Even though longer postoperative remission periods are reported for children, most studies have monitored clinical recurrence rates instead of endoscopic follow-up [2,[12][13][14][15]. As clinical symptoms are frequently absent and serum biochemical markers normal until significant inflammatory changes have developed, ileocolonoscopy with histological verification should be considered as the gold standard for assessing disease activity and postoperative recurrence [6,[8][9][10]16].…”

mentioning

confidence: 99%

Fecal calprotectin in the prediction of postoperative recurrence of Crohn's disease in children and adolescents

Hukkinen

Pakarinen

Merras‐Salmio

et al. 2016

Journal of Pediatric Surgery

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a b s t r a c t a r t i c l e i n f oBackground: Fecal calprotectin (FC) correlates with endoscopic recurrence of Crohn's disease (CD) in adults but has not been studied among children postoperatively. We aimed to analyze whether FC relates with postoperative CD recurrence in children. Methods: Altogether 51 postoperative endoscopies and FC measurements from 22 patients having undergone surgery for CD at age ≤18 years were included. Results: Ileocecal resection (n = 15), small bowel resection (n = 6), or left hemicolectomy (n = 1) was performed at median age of 15.1 (interquartile range 14.4-17.6) years. Following surgery, FC decreased significantly (659 vs. 103 μg/g, p = 0.001). During median follow-up of 5.7 (4.2-7.7) years, either endoscopic or histological recurrence occurred in 17 patients (77%). FC N139 μg/g at time of endoscopy or FC increase of 79 μg/g compared to first postoperative value was suggestive of endoscopic recurrence (Rutgeerts score i2-i4), while FC N101 μg/g or increase of 21 μg/g indicated histological recurrence. Best accuracy for prediction of recurrence was obtained by combining FC at endoscopy and the postoperative increase of FC. The corresponding AUROC values were 0.74 (95% 0.58-0.89) for endoscopic recurrence whereas 0.81 (95% CI 0.67-0.95) for histological recurrence. Conclusion: FC is a useful surrogate marker of postoperative recurrence also in pediatric CD patients.

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Decrease in primary but not in secondary abdominal surgery for Crohn's disease: nationwide cohort study, 1990–2014

Kalman

Everhov

Nordenvall

et al. 2020

British Journal of Surgery

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Background Treatment of patients with Crohn's disease has evolved in recent decades, with increasing use of immunomodulatory medication since 1990 and biologicals since 1998. In parallel, there has been increased use of active disease monitoring. To what extent these changes have influenced the incidence of primary and repeat surgical resection remains debated. Methods In this nationwide cohort study, incident patients of all ages with Crohn's disease, identified in Swedish National Patient Registry between 1990 and 2014, were divided into five calendar periods of diagnosis: 1990–1995 and 1996–2000 with use of inpatient registries, 2001, and 2002–2008 and 2009–2014 with use of inpatient and outpatient registries. The cumulative incidence of first and repeat abdominal surgery (except closure of stomas), by category of surgical procedure, was estimated using the Kaplan–Meier method. Results Among 21 273 patients with Crohn's disease, the cumulative incidence of first abdominal surgery within 5 years of Crohn's disease diagnosis decreased continuously from 54·8 per cent in 1990–1995 to 40·4 per cent in 1996–2000 (P < 0·001), and again from 19·8 per cent in 2002–2008 to 17·3 per cent in 2009–2014 (P < 0·001). Repeat 5‐year surgery rates decreased from 18·9 per cent in 1990–1995 to 16·0 per cent in 1996–2000 (P = 0·009). After 2000, no further significant decreases were observed. Conclusion The 5‐year rate of surgical intervention for Crohn's disease has decreased significantly, but the rate of repeat surgery has remained stable despite the introduction of biological therapy.

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OP18 Long-term outcome after first intestinal resection in paediatric-onset Crohn's disease: A population-based study

Cited by 7 publications

References 0 publications

Surgery for children with Crohn's disease: indications, complications and outcome

Surgery for children with Crohn's disease: indications, complications and outcome

Fecal calprotectin in the prediction of postoperative recurrence of Crohn's disease in children and adolescents

Decrease in primary but not in secondary abdominal surgery for Crohn's disease: nationwide cohort study, 1990–2014

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