Journal of Crohn's & colitis · 2025
Clinical outcome after entero-enteric anastomosis for Crohn's disease: a case-control study.
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Neri Benedetto, Schiavone Sara Concetta, Mancone Roberto, Fiorillo Mariasofia, Fonsi Antonio, Calabrese Emma, Perugini Lorenzo, Piccione Gaspare, Di Matteo Francesco Maria, Marafini Irene, Lolli Elisabetta, Sica Giuseppe Sigismondo, Monteleone Giovanni, Biancone Livia
Аннотация
BACKGROUND AND AIMS: The outcome of Crohn's Disease (CD) patients with entero-enteric anastomosis (EEA) after small bowel resection is undefined. The primary aim of the present case-control study was to compare the clinical recurrence rate within the first 5 years after surgery in CD patients with small bowel EEA (Cases) versus age-matched patients with ileo-colonic anastomosis (ICA, Controls).
METHODS: All CD patients with EEA were matched for age at diagnosis (±5 years) and smoking habits with two Controls with ICA. Inclusion criteria were: (1) age ≥18 years; (2) EEA or ICA for CD; (3) ≥5 years of follow-up after surgery. Exclusion criteria were: (1) missing data; (2) ostomy; (3) stricturoplasty.
RESULTS: The study population included 51 CD patients with EEA and 102 matched Controls with ICA. During the first 5 years after surgery, clinical recurrence and CD-related hospitalizations were more frequent in Cases (34 [66.7%] vs 43 [42.2%], P = .007; 25 [49%] vs 23 [22.5%], P = .001). During the same period, use of corticosteroids, immunosuppressors, and biologics were also more frequent in Cases (26 [50.9%] vs 18 [17.6%], P < .0001; 21 [41.2%] vs 24 [23.5%], P = .03; 23 [45.1%] vs 15 [14.7%], P = .03). Survival time from clinical recurrence and hospitalization were shorter in Cases (2.36 [1.29-4.35], P = .003; 1.71 [1.06-2.77], P = 0.02). EEA and use of immunosuppressors before surgery were risk factors for clinical recurrence and CD-related hospitalization at 5 years (2.68 [1.11-6.45], P = .02; 2.61 [1.21-5.6], P = .01; 2.53 [1.05-6.09], P = .03; 2.44 [1.18-5], P = .01).
CONCLUSIONS: The clinical outcome is more severe in CD patients with EEA than in those with ICA, being associated with a higher rate of clinical recurrence and hospitalization after surgery.
METHODS: All CD patients with EEA were matched for age at diagnosis (±5 years) and smoking habits with two Controls with ICA. Inclusion criteria were: (1) age ≥18 years; (2) EEA or ICA for CD; (3) ≥5 years of follow-up after surgery. Exclusion criteria were: (1) missing data; (2) ostomy; (3) stricturoplasty.
RESULTS: The study population included 51 CD patients with EEA and 102 matched Controls with ICA. During the first 5 years after surgery, clinical recurrence and CD-related hospitalizations were more frequent in Cases (34 [66.7%] vs 43 [42.2%], P = .007; 25 [49%] vs 23 [22.5%], P = .001). During the same period, use of corticosteroids, immunosuppressors, and biologics were also more frequent in Cases (26 [50.9%] vs 18 [17.6%], P < .0001; 21 [41.2%] vs 24 [23.5%], P = .03; 23 [45.1%] vs 15 [14.7%], P = .03). Survival time from clinical recurrence and hospitalization were shorter in Cases (2.36 [1.29-4.35], P = .003; 1.71 [1.06-2.77], P = 0.02). EEA and use of immunosuppressors before surgery were risk factors for clinical recurrence and CD-related hospitalization at 5 years (2.68 [1.11-6.45], P = .02; 2.61 [1.21-5.6], P = .01; 2.53 [1.05-6.09], P = .03; 2.44 [1.18-5], P = .01).
CONCLUSIONS: The clinical outcome is more severe in CD patients with EEA than in those with ICA, being associated with a higher rate of clinical recurrence and hospitalization after surgery.