P321 Recurrence of Crohn's disease after definitive stoma: A retrospective study in 83 patients

Koriche, Dine; Salleron, Julia; Gower‐Rousseau, Corinne; Cortot, Antoine; Colombel, J.-F.; Zerbib, Philippe

doi:10.1016/s1873-9946(12)60341-9

Cited by 2 publications

(10 citation statements)

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“…Of 2017 unique studies identified using our search strategy, 17 studies met our inclusion criteria. 10,11,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] In addition, we identified one abstracts from conference proceedings 31 and hence, included a total of 18 studies for quantitative synthesis. Figure 1 shows the schematic diagram of study selection.…”

Section: Resultsmentioning

confidence: 99%

“…some patients were operated before availability of anti-TNF agents in 1998 and others after 1998). Among the eight studies that explicitly reported definition of clinical recurrence, 10,17,23,25,27,28,30,31 two did not 17,31 required confirmation of disease activity (through endoscopy and/or imaging) in patients with new onset gastrointestinal symptoms. Six studies were performed in North America 11,16,19,23,24,30 and 12 in Europe.…”

Section: Resultsmentioning

confidence: 99%

“…Among the eight studies that explicitly reported definition of clinical recurrence, two did not required confirmation of disease activity (through endoscopy and/or imaging) in patients with new onset gastrointestinal symptoms. Six studies were performed in North America and 12 in Europe . Of note, three studies were performed at a single centre, of which two reported clinical recurrence over a non‐overlapping period, and one reported surgical recurrence; hence, all three studies contributed to the analyses.…”

Section: Resultsmentioning

confidence: 99%

“…Overall, the studies were at moderate risk of bias, 17 were performed in referral centres 10,11,[16][17][18][19][20][21][22][23][24][25][26][28][29][30][31] and one in population, 27 17 were retrospective 10, 16-31 and one prospective. 11 Table S1 details the quality of these included studies according to NICE criteria.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…Among three studies reporting time to recurrence, the median time to recurrence ranged from 1 to 5.6 years. 28,29,31 In six studies reporting the location of recurrence in 132 patients, 81% patients experienced ileal, 3% jejunal, 2% upper gastrointestinal tract and 14% extensive small bowel recurrence. 10,17,20,21,25,30 Rates of clinical recurrence were similar among studies in the pre-biological and biological era (published before 1998 vs. after 1998: 26.9% vs. 30.0%, P = 0.64).…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

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Systematic review with meta‐analysis: recurrence of Crohn's disease after total colectomy with permanent ileostomy

Fuméry

Dulai

Meirick

et al. 2016

Aliment Pharmacol Ther

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Background Subtotal or total colectomy or proctocolectomy with permanent ileostomy (TC-PI) may be a treatment option for medically refractory colonic Crohn's disease (CD). Aim To perform a systematic review and meta-analysis to evaluate the rate, risk factors and outcomes of CD recurrence after TC-PI. Methods In a systematic review ending March 31, 2016, we identified 18 cohort studies (1438 adults) who underwent TC-PI for colonic CD (median follow-up, 7.4 years; interquartile range, 5.3-9.0). We estimated pooled rates (with 95% confidence interval [CI]) of clinical and surgical recurrence, and risk factors for disease recurrence. Results On meta-analysis, the risk of clinical recurrence after TC-PI was 28.0% (95% CI, 21.7-35.3; 14 studies, 260/1004 patients), with a 5- and 10-year median cumulative rate of 23.5% (range, 7-35) and 40% (range, 11-60), respectively. The risk of surgical recurrence was 16.0% (95% CI, 11.1-22.7; 10 studies; 183/1092 patients), with a 5- and 10-year median cumulative rate of 10% (range, 3-29) and 18.5% (range, 14-34), respectively. The risk of clinical and surgical recurrence in patients without ileal disease at baseline was 11.5% (95% CI, 7.7-16.8) and 10.4% (95% CI, 4.5-22.5), respectively. History of ileal disease was associated with 3.2 times higher risk of disease recurrence (RR, 3.2; 95% CI, 1.8-5.6). Other inconsistent risk factors for disease recurrence were penetrating disease and young age at disease onset. Conclusions Small bowel clinical recurrence occurs in about 28% of patients after TC-PI for colonic CD. Disease recurrence risk is 3.2 times higher in patients with history of ileal disease, and continued medical therapy may be advisable in this population. In patients without ileal inflammation at surgery, continued endoscopic surveillance may identify asymptomatic disease recurrence to guide therapy.

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