Case Series: Does a Combination of Anti-TNF Antibodies and Transient Ileal Fecal Stream Diversion in Severe Crohnʼs Colitis With Perianal Fistula Prevent Definitive Stoma?

Uzzan, Mathieu; Stéfanescu, Carmen; Maggiori, Léon; Bouhnik, Yoram

doi:10.1038/ajg.2013.188

Cited by 15 publications

(26 citation statements)

References 8 publications

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“…Of 1402 unique studies identified using our search strategy, 15 studies met our inclusion criteria. [7][8][9][10][16][17][18][19][20][21][22][23][24][25][26] We identified an additional unpublished study through personal communication with content experts, 27 and hence, included a total of 16 studies in our meta-analysis. The primary reasons for exclusion after full-text review were: lack of data on long-term efficacy of FD, specifically rates of restoration of bowel continuity (six studies), [28][29][30][31][32][33] FD performed for colonic CD without severe perianal CD (seven studies), 5,6,[34][35][36][37][38] and reporting recurrence of CD after intended permanent ileostomy for colonic and/or perianal CD (five studies).…”

Section: Resultsmentioning

confidence: 99%

“…all patients were operated and analysed before the availability of anti-TNF agents), 7,16,17,20,22,23,26 seven studies in the biological era (i.e. all patients operated and analysed after 1998, although it is not always clear what proportion were treated with anti-TNF agents before and/or after FD), 9,18,19,21,24,25,27 and two studies in the overlapping period (i.e. some patients were operated before availability of anti-TNF agents in 1998 and others after 1998).…”

Section: Resultsmentioning

confidence: 99%

“…some patients were operated before availability of anti-TNF agents in 1998 and others after 1998). 8,10 Six studies were performed in North America (including one paediatric study), 9,10,16,18,22,24 seven studies in Europe, 7,17,19,21,23,25,26 and one each in Japan 20 and Australia 8 ; one study was a multicentre cohort conducted in Europe and USA. 27 Perianal fistulae, anorectal sepsis and severe proctitis were the leading indications for temporary FD.…”

Section: Resultsmentioning

confidence: 99%

“…Fourteen studies (373 patients) reported early clinical response (usually defined clinically) within 3-6 months after FD for refractory perianal CD. 7,8,[16][17][18][19][20][21][22][23][24][25][26][27] On meta-analysis, 63.8% of patients (95% CI: 54.1-72.1) experienced improvement in symptoms after FD, with substantial heterogeneity (I 2 = 64%; Figure 2). (6) Recurrence rates after permanent ileostomy (5) FD performed for colonic, not perianal CD (7) Unrelated to CD (2) Unrelated to find full article (1) 1 additional records identified through other sources (author contact) Scopus -496 of bowel continuity after temporary FD.…”

Section: Characteristics and Quality Of Included Studiesmentioning

confidence: 99%

“…(6) Recurrence rates after permanent ileostomy (5) FD performed for colonic, not perianal CD (7) Unrelated to CD (2) Unrelated to find full article (1) 1 additional records identified through other sources (author contact) Scopus -496 of bowel continuity after temporary FD. [7][8][9][10][16][17][18][19][20][21][22][23][24][25][26][27] On meta-analysis, restoration of bowel continuity was attempted only in 34.5% of patients (95% CI: 27.0-42.8), with substantial heterogeneity (I 2 = 62%), although FD was performed as a temporising measure with the intention of restoring bowel continuity in the future (Figure 3). For the remaining patients, suboptimal clinical response and/or patient preference precluded attempting takedown of stoma.…”

Section: Characteristics and Quality Of Included Studiesmentioning

confidence: 99%

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Systematic review with meta‐analysis: faecal diversion for management of perianal Crohn's disease

Singh

Ding

Mathis

et al. 2015

Aliment Pharmacol Ther

157

118

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Summary Background Temporary faecal diversion is sometimes used for management of refractory perianal Crohn's disease (CD) with variable success. Aims To perform a systematic review with meta‐analysis to evaluate the effectiveness, long‐term outcomes and factors associated with success of temporary faecal diversion for perianal CD. Methods Through a systematic literature review through 15 July 2015, we identified 16 cohort studies (556 patients) reporting outcomes after temporary faecal diversion. We estimated pooled rates [with 95% confidence interval (CI)] of early clinical response, attempted and successful restoration of bowel continuity after temporary faecal diversion (without symptomatic relapse), and rates of re‐diversion (in patients with attempted restoration) and proctectomy (with or without colectomy and end‐ileostomy). We identified factors associated with successful restoration of bowel continuity. Results On meta‐analysis, 63.8% (95% CI: 54.1–72.5) of patients had early clinical response after faecal diversion for refractory perianal CD. Restoration of bowel continuity was attempted in 34.5% (95% CI: 27.0–42.8) of patients, and was successful in only 16.6% (95% CI: 11.8–22.9). Of those in whom restoration was attempted, 26.5% (95% CI: 14.1–44.2) required re‐diversion because of severe relapse. Overall, 41.6% (95% CI: 32.6–51.2) of patients required proctectomy after failure of temporary faecal diversion. There was no difference in the successful restoration of bowel continuity after temporary faecal diversion in the pre‐biological or biological era (13.7% vs. 17.6%, P = 0.60), in part due to selection bias. Absence of rectal involvement was the most consistent factor associated with restoration of bowel continuity. Conclusions Temporary faecal diversion may improve symptoms in approximately two‐thirds of patients with refractory perianal Crohn's disease, but bowel restoration is successful in only 17% of patients.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Characteristics and Quality Of Included Studiesmentioning

confidence: 99%

Section: Characteristics and Quality Of Included Studiesmentioning

confidence: 99%

See 3 more Smart Citations

Systematic review with meta‐analysis: faecal diversion for management of perianal Crohn's disease

Singh

Ding

Mathis

et al. 2015

Aliment Pharmacol Ther

157

118

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Postoperative results and complications of fecal diversion for anorectal Crohn’s disease

et al. 2022

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Purpose Fecal diversion is a less-invasive technique that can alleviate symptoms in patients with refractory anorectal Crohn’s disease. However, complications, including recurrence of residual anorectal Crohn’s disease, may develop. We aimed to evaluate the postoperative results and complications associated with fecal diversion in patients with refractory anorectal Crohn’s disease. Methods We enrolled 1218 Crohn’s disease patients who underwent laparotomy at our institute. We retrospectively analyzed the clinical features of 174 patients who underwent fecal diversion for refractory anorectal Crohn’s disease, complications of the diverted colorectum, and the incidence and risk factors for proctectomy after fecal diversion. Results After fecal diversion, 74% of patients showed improved symptoms. However, bowel continuity restoration was successful in four patients (2.2%), and anorectal Crohn’s disease recurred in all patients. Seventeen patients developed cancer with a poor prognosis. The rate of conversion to proctectomy after fecal diversion was 41.3%, and the risk factors included rectal involvement (p = 0.02), loop-type stoma (p < 0.01), and the absence of treatment with biologics after fecal diversion (p = 0.03). Conclusion Fecal diversion for refractory anorectal Crohn’s disease can improve clinical symptoms. Patients with rectal involvement or loop-type stoma have a greater risk of requiring proctectomy following fecal diversion. The administration of biologic may decrease the rate of proctectomy.

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Interdisciplinary Management of Perianal Crohn's Disease

Lightner

Faubion

Fletcher

2017

Gastroenterology Clinics of North America

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Case Series: Does a Combination of Anti-TNF Antibodies and Transient Ileal Fecal Stream Diversion in Severe Crohnʼs Colitis With Perianal Fistula Prevent Definitive Stoma?

Cited by 15 publications

References 8 publications

Systematic review with meta‐analysis: faecal diversion for management of perianal Crohn's disease

Systematic review with meta‐analysis: faecal diversion for management of perianal Crohn's disease

Postoperative results and complications of fecal diversion for anorectal Crohn’s disease

Interdisciplinary Management of Perianal Crohn's Disease

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