Early surgery in Crohn’s disease a benefit in selected cases

An, Vinna; Cohen, Lauren; Lawrence, Matthew; Thomas, Michelle; Andrews, Jane M.; Moore, James W.

doi:10.4240/wjgs.v8.i7.492

Cited by 33 publications

(28 citation statements)

References 30 publications

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“…Successive resections leading to progressive shortening of the small bowel can have devastating clinical consequences. However, recent studies have demonstrated the benefit of early resection, indicating that optimal treatment of CD (especially ileocecal disease) does not necessarily dictate minimizing resection [42, 43]. Thus, understanding whether biologics can affect recurrence and re-operation rates following an initial operation is an important factor in operative planning.…”

Section: Crohn’s Diseasementioning

confidence: 99%

Surgery in the age of biologics

Wong

Roth

Feuerstein

et al. 2019

Gastroenterology Report

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Since the introduction of the first anti-tumor necrosis factor antibodies in the late 1990s, biologic therapy has revolutionized the medical treatment of patients with inflammatory bowel disease (IBD). Nevertheless, surgery continues to play a significant role in treating IBD patients. Rates of intestinal resection in patients with Crohn’s disease or colectomy in ulcerative colitis are reducing but not substantially over the long term. An increasing variety of biologic medications are now available to treat IBD patients in various clinical situations. Consequently, a number of questions persist about how biologic medications affect the need for surgery and overall course in IBD patients. Given the trend for earlier and more frequent use of biologic medications in IBD patients, a working knowledge of the effects of these medications on surgical decision-making and outcomes is essential for the practicing colorectal surgeon and gastroenterologist. This review seeks to summarize the relevant literature surrounding biologic use and IBD surgery with a focus on the effect of biologics on the frequency, type and complications of surgery in this ‘age of biologics’.

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Section: Crohn’s Diseasementioning

confidence: 99%

Surgery in the age of biologics

Wong

Roth

Feuerstein

et al. 2019

Gastroenterology Report

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“…These complications were identified in the studied group of patients in varying percentages -but there was a tendency towards surgical interventions in emergency settings in contradiction with literature where there is a changing trend towards surgery in elective settings (1). The benefit of early surgery in selected ileocolic CD cases seems to offer future better results regarding surgical reinterven-tions and hospital admissions when compared to medical therapy as demonstrated by the study group of Vinna An et al on 157 patients (5). This evolution of elective surgery is also sustained by Christopher Ma et.…”

Section: Discussionmentioning

confidence: 64%

Clinical Pattern of Surgical Crohn Disease Patients

Slavu¹,

Tulin²,

Aleçu³

et al. 2018

chr

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Backround/Objective: The aim of investigation was to evaluate if there is a pattern regarding the anatomical location of the disease and type of surgery performed/surgical indication. Also a analysis was performed regarding the complication rate in two subgroups deriving from urban and rural environments. Data was obtained from the medical records of patients with CD and centralized. Tests of statistical analysis included the CHY-SQUARE test and the results were presented as a retrospective, longitudinal study. The group was formed of 60 patients. Patients with ileocolic disease were frequently diagnosed with obstruction and benefited from an enterectomy with anastomosis. Patients with colonic disease were frequently diagnosed with perforation and benefited from colectomy and stomy. Patients from rural areas had a milder evolution when compared with patients from urban enviroments. Although most patients with CD eventually require surgery, the indication could be anticipated by recognition of the concept of clinical patterns, and type of surgery required could be predicted if the clinical aspect of the patient/disease were identified.

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“…It has been reported that 20%-40% of patients with CD require surgery in the first year after diagnosis, and up to 80% require surgery at some time during their disease. 10 When patients with CD have acute complications such as intestinal obstruction, fistula, perforation or stenosis, or when medical treatment is ineffective or intolerable, surgery is usually inevitable. And long-term studies have shown that after resection, 50% of patients will never require reoperation.…”

Section: Introductionmentioning

confidence: 99%

“…Some evidence suggests that early surgery in patients with CD may lead to a longer time to clinical recurrence and a lower long-term reoperation rate (14% at 5 years) compared with later surgery (30% at 5 years). 10 The 'Laparoscopic ileocaecal resection versus infliximab for terminal ileitis in Crohn's disease' (LIR!C) trial compared laparoscopic ileocaecal resection with IFX therapy for patients with Crohn's terminal ileitis who failed conventional therapy, and through the study, researchers found that the early surgery and IFX groups had similar endoscopic remission at 1 year, while the surgery group had better general quality of life and less medical consumption. 20 Therefore, compared with the initial IFX treatment, we hold the opinion that early surgery can further reduce the side effects of drugs, improve the quality of life and reduce medical expenses.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic bowel resection combined with infliximab treatment (LaRIC) versus infliximab for terminal ileitis in Crohn’s disease: a randomised, controlled, open-label trial

et al. 2020

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IntroductionCrohn’s disease is a chronic inflammatory disease of the gastrointestinal tract with an increasing incidence and prevalence worldwide. The early use of anti-tumour necrosis factor agents, such as infliximab, in patients with an aggressive form of Crohn’s disease has become part of routine practice. However, infliximab has limitations, and early surgery might benefit patients more. The objective of this study was to compare laparoscopic bowel resection with infliximab treatment in patients with moderately or severely active Crohn’s disease with respect to endoscopic remission. The laparoscopic bowel resection combined with infliximab treatment trial is the first randomised controlled trial to demonstrate if early surgery can improve the outcome of patients with Crohn’s disease with limited non-stricturing disease treated with infliximab.Methods and analysisThis is a randomised, open-label, controlled trial at Renji Hospital. In this study, a total of 106 adult patients aged 18–80 years with moderately or severely active and steroid-dependent or steroid-resistant Crohn’s disease of the distal ileum will be randomly assigned in a 1:1 ratio to the control and surgery groups. The primary outcome is 12-month endoscopic remission measured by the Simple Endoscopic Score for Crohn’s Disease in the control group and the Rutgeerts score in the surgery group. The secondary outcomes are clinical remission, surgery rate, quality of life, Crohn’s disease-related medical costs and Crohn’s disease-related morbidity. The patients will be followed up every 6 months after randomisation through intestinal magnetic resonance enterography and colonoscopy for either 3 years or until clinical remission.Ethics and disseminationAll participants will provide informed consent. The protocol has been approved by the Medical Ethical Committee of the Academic Medical Center in Shanghai (No KY2019-180). Results will be disseminated through peer-reviewed journals and scientific conference presentations.Trial registration numberChiCTR2000029323.

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Early surgery in Crohn’s disease a benefit in selected cases

Abstract: Our data supports other recent studies suggesting that patients with ileocolonic CD may have a more benign disease course if undergoing early surgical intervention, with fewer admissions to hospital and a trend to reduced overall operation rates.

Cited by 33 publications

References 30 publications

Surgery in the age of biologics

Surgery in the age of biologics

Clinical Pattern of Surgical Crohn Disease Patients

Laparoscopic bowel resection combined with infliximab treatment (LaRIC) versus infliximab for terminal ileitis in Crohn’s disease: a randomised, controlled, open-label trial

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