ECCO Guidelines on Therapeutics in Crohn’s Disease: Surgical Treatment

Torres, Joana; Bonovas, Stefanos; Doherty, Glen; Kucharzik, Torsten; Gisbert, Javier P.; Raine, Tim; Adamina, Michel; Armuzzi, Alessandro; Bachmann, Oliver; Bager, Palle; Biancone, Livia; Bokemeyer, Bernd; Bossuyt, Peter; Burisch, Johan; Collins, Paul; El‐Hussuna, Alaa; Ellul, Pierre; Frei-Lanter, Cornelia; Furfaro, Federica; Gingert, Christian; Gionchetti, Paolo; Gomollón, Fernando; González-Lorenzo, Marién; Gordon, Hannah; Hlavatý, Tibor; Juillerat, Pascal; Κατσάνος, Κωνσταντίνος; Kopylov, Uri; Krustiņš, Eduards; Lytras, Theodore; Maaser, Christian; Magro, Fernando; Marshall, John K.; Myrelid, Pär; Pellino, Gianluca; Rosa, Isadora; Sabino, J; Savarino, Edoardo; Spinelli, Antonino; Stassen, Laurents P. S.; Uzzan, Mathieu; Vavricka, Stephan R.; Verstockt, Bram; Warusavitarne, Janindra; Zmora, Oded; Fiorino, Gionata

doi:10.1093/ecco-jcc/jjz187

Cited by 630 publications

(440 citation statements)

References 132 publications

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“…Therefore, we hypothesise that also for EBD of small bowel strictures using EBD the most probable standard of care is to dilate stricture with a length of ≤5 cm. 19,39 There is an ongoing debate on the efficacy of EBD for de novo vs anastomotic CD strictures. In our study, we report that EBD of de novo strictures was associated with a lower short-term clinical efficacy.…”

Section: Discussionmentioning

confidence: 99%

“…11,13,14,17 Accordingly, EBD of CD strictures is part of current guideline recommendations for the treatment of ileal strictures. 14,18,19 However, most studies evaluated EBD for terminal ileal and ileocolic anastomotic strictures which can be reached by standard ileocolonoscopy and the evidence for EBD of small bowel strictures which can only be reached by BAE is scarce (Figure 1). 7,8,11,19 To address this knowledge gap, this pooled analysis of international cohort studies aimed to evaluate the efficacy and safety of BAE-based EBD of small bowel CD strictures.…”

Section: Bae Has Been First Described In 2001 Bymentioning

confidence: 99%

“…14,18,19 However, most studies evaluated EBD for terminal ileal and ileocolic anastomotic strictures which can be reached by standard ileocolonoscopy and the evidence for EBD of small bowel strictures which can only be reached by BAE is scarce (Figure 1). 7,8,11,19 To address this knowledge gap, this pooled analysis of international cohort studies aimed to evaluate the efficacy and safety of BAE-based EBD of small bowel CD strictures. Furthermore, we used individual patient data sets from 218 patients to identify risk factors that might be associated with clinical efficacy, symptom recurrence, need for repetitive EBD and surgery.…”

Section: Bae Has Been First Described In 2001 Bymentioning

confidence: 99%

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Systematic review with meta‐analysis: efficacy of balloon‐assisted enteroscopy for dilation of small bowel Crohn's disease strictures

Bettenworth¹,

Bokemeyer²,

Kou³

et al. 2020

Aliment Pharmacol Ther

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SummaryBackgroundEvidence for endoscopic balloon dilation of small intestinal strictures in Crohn's disease (CD) using balloon‐assisted enteroscopy is scarce.AimTo evaluate endoscopic balloon dilation for the treatment of small intestinal CD strictures using balloon‐assisted enteroscopy.MethodsCitations in Embase, MEDLINE, and Cochrane were systematically reviewed. In a meta‐analysis of 18 studies with 463 patients and 1189 endoscopic balloon dilations, technical success was defined as the ability to dilate a stricture. Individual data were also obtained on 218 patients to identify outcome‐relevant risk factors.ResultsIn the pooled per‐study analysis, technical success rate of endoscopic balloon dilation was 94.9%, resulting in short‐term clinical efficacy in 82.3% of patients. Major complications occurred in 5.3% of patients. During follow‐up, 48.3% of patients reported symptom recurrence, 38.8% were re‐dilated and 27.4% proceeded to surgery. On the per‐patient‐based multivariable analysis, that patients with disease activity in the small intestine had lower short‐term clinical efficacy (odds ratio 0.32; 95% confidence interval 0.14‐0.73, P = 0.007). Patients with concomitant active disease in the small and/or large intestine had an increased risk to proceed toward surgery (hazard ratio 1.85; 95% confidence interval 1.09‐3.13, P = 0.02 and hazard ratio 1.77; 95% confidence interval 1.34‐2.34, P < 0.001).ConclusionsBalloon‐assisted enteroscopy for dilatation of CD‐associated small intestinal strictures has high short‐term technical and clinical efficacy and low complication rates. However, up to two‐thirds of patients need re‐dilation or surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Bae Has Been First Described In 2001 Bymentioning

confidence: 99%

Section: Bae Has Been First Described In 2001 Bymentioning

confidence: 99%

See 1 more Smart Citation

Systematic review with meta‐analysis: efficacy of balloon‐assisted enteroscopy for dilation of small bowel Crohn's disease strictures

Bettenworth¹,

Bokemeyer²,

Kou³

et al. 2020

Aliment Pharmacol Ther

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“…The algorithms presented in this manuscript should point out the practicability of this review. They are based on the guidelines of the European Crohn's and Colitis Organization (ECCO) and include also their very recently pub-lished updates (January 2020) [12][13][14] and are expert based opinions (without voting). A systematic review of the literature was not repeated (but done for the ECCO guidelines).…”

Section: Introductionmentioning

confidence: 99%

Treatment Algorithms for Crohn’s Disease

Sulz

Burri

Michetti³

et al. 2020

Digestion

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Background: Treatment of Crohn's disease (CD) patients is complex as therapy choices depend on a variety of factors, such as location and severity of inflammation, disease behavior (inflammatory, stricturing or penetrating) but also comorbidities, extra-intestinal manifestations, the patient's age, and previous therapies. Subsequently, the choice of treatment should be tailored to the individual patient. Summary: This article gives the reader therapy algorithms as a guide through different CD scenarios to support the physician's decision making. New compounds introduced in CD therapy in recent years justify such an update on standard approaches. Ustekinumab and vedolizumab and their positions within the treatment options are discussed. Fistulizing perianal disease and postoperative medical prophylaxis are depicted in separate chapters with own algorithms. Key Messages: In recent years, a variety of new drugs became available to treat patients with CD-especially those who are antitumor necrosis factor (TNF) experienced with ongoing inflammation. The definitive role of vedolizumab and ustekinumab is not yet fully clarified. However, with the advantage of good safety profiles over TNF-inhibitors, these drugs will be more frequently used in the near future, also as first-line biologicals, compared to TNF-inhibitors. Concerning treatment of fistulizing disease, the knowledge of the exact anatomy of the fistula is of major importance. An interdisciplinary discussion involving gastroenterologists, surgeons, and in some cases gynecologists may help to optimize the treatment plan. Regarding the postsurgical setting in CD patients, according to the very recent Cochrane Network meta-analysis, mesalazine should be at least positioned equivalent to thiopurines and TNF-inhibitors, as shown in our algorithm.

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“…B OWEL OBSTRUCTION, ABSCESS, fulminant colitis and concern for malignancy are indications in which surgery would still be necessary, but this will require careful discussion by institution-specific boards and multi-disciplinary teams. 19,20 In addition, we recommend testing of every patient for COVID-19 before surgery is performed. One recent report highlighted an increased mortality even for relatively short surgical procedures in case of COVID-19 infection.…”

Section: Question 6: What To Do When Surgery Is Needed?mentioning

confidence: 99%