Postoperative Complications after Ileocecal Resection in Crohn’s Disease: A Prospective Study From the REMIND Group

Fuméry, Mathurin; Seksik, Philippe; Auzolle, Claire; Munoz‐Bongrand, Nicolas; Gornet, Jean–Marc; Boschetti, Gilles; Cotte, Eddy; Buisson, Anthony; Dubois, Anne; Pariente, Benjamin; Zerbib, Philippe; Chafaı̈, Najim; Stefănescu, Carmen; Panís, Yves; Marteau, Philippe; Pautrat, Karine; Sabbagh, Charles; Filippi, Jérôme; Chévrier, Marc; Houzé, Pascal; Jouven, Xavier; Tréton, Xavier; Allez, Matthieu

doi:10.1038/ajg.2016.541

Cited by 155 publications

(119 citation statements)

References 23 publications

Supporting

Mentioning

108

Contrasting

Order By: Relevance

“…Of these, one had no English abstract [39] and three had no English full text [40-42]. The main features of the 14 full-text excluded articles are summarized in Table 1 [43-56] – eight of them had no separate results on different nutritional regimens or on treated patients [44, 47-50, 52-54] and four had no data on EN regimen [43, 45, 55, 56]; two other articles [46, 51] met the inclusion criteria but overlapped patients with a third study which contained a larger number of patients and was therefore detrimentally included. All studies in which supplemental EN was used with conventional diet or with PN did not meet the inclusion criteria.…”

Section: Resultsmentioning

confidence: 99%

Preoperative Enteral Nutrition and Surgical Outcomes in Adults with Crohn’s Disease: A Systematic Review

Rocha

Bessa

Lago

et al. 2018

GE Port J Gastroenterol

View full text Add to dashboard Cite

Background and Aim: Enteral nutrition (EN) is applicable to adult Crohn’s disease (CD) in treating malnutrition and in inducing remission – here as a less effective alternative than corticosteroids. The purpose of this review is to determine whether preoperative EN impacts postoperative complications of adult CD, either by means of nutritional or therapeutic effects. Summary: A systematic review of English written full-text research articles published between January 1990 and November 2017, including adult patients undergoing abdominal surgery for complicated CD after EN, was performed. Four studies out of 22 were selected, all of which institutional, retrospective, case-control cohorts, one classified as “good quality” and three as “poor quality,” as rated by the Newcastle-Ottawa Scale. The application of inclusion and exclusion criteria resulted in a non-intentional absence of studies referring to supplemental EN among those reviewed. The reduced number of heterogeneous eligible studies impeded meta-analysis. In all studies, exclusive EN (EEN) was used and well tolerated, allowing to defer or even avoid surgery altogether, improving patients’ global state. The two studies with the greatest number of patients found preoperative EEN to be an independent factor against infectious and non-infectious complications in 219 patients and against anastomotic leaks or abscesses in 38 patients. Also, in univariate analysis, EEN was found to increase preoperative immunosuppressant-free intervals and to protect against anastomotic dehiscences, intra-abdominal abscesses, surgical wound infections, ileus, stomas, and reoperations in the largest study; in another study it was related to fewer intra-abdominal septic complications. Key Messages: All reviewed studies are retrospective and, consequently, of limited relevance. Nonetheless, all of them call the attention of the scientific community to the potential benefits of preoperative EEN on postoperative outcomes in adult CD, calling for prospective multi-institutional studies and randomized controlled trials.

show abstract

Section: Resultsmentioning

confidence: 99%

Preoperative Enteral Nutrition and Surgical Outcomes in Adults with Crohn’s Disease: A Systematic Review

Rocha

Bessa

Lago

et al. 2018

GE Port J Gastroenterol

View full text Add to dashboard Cite

show abstract

“…However, the influence of these drugs on postoperative outcome is matter of debate. While Fumery et al described an increased risk of complications [15], a recent meta-analysis did not find any association between immunomodulating therapy and postoperative outcome [58]. Malnutrition on the other hand is common (up to 85%) among Crohn’s patients awaiting surgery and is a well-known risk factor for adverse postoperative outcome in surgical patients in general [59].…”

Section: Discussionmentioning

confidence: 99%

“…For Crohn’s patients needing surgery, anastomotic dehiscence, intraabdominal abscess, and fistula, regrouped as intraabdominal septic complications, represent most feared complications [60,61]. Intraabdominal septic complications hinder the postoperative course in up to 20% of patients with potentially severe consequences [15,62] and either reoperation or percutaneous drainage is needed in most cases. Hence, efforts to improve modifiable risk factors before surgery are of utmost importance.…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, it should be emphasized that incidence of surgical procedures for Crohn’s disease did not decrease after introduction of infliximab [14]. Postoperative complication rates, including most feared intra-abdominal septic complications, reach 30% [15,16]. Nutritional guidelines for Crohn’s patients have been published by the European Society for Clinical nutrition and metabolism (ESPEN) in 2006 [17] and 2016 [4].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Preoperative Nutritional Conditioning of Crohn’s Patients—Systematic Review of Current Evidence and Practice

Grass¹,

Pache²,

Martín³

et al. 2017

Nutrients

View full text Add to dashboard Cite

Crohn’s disease is an incurable and frequently progressive entity with major impact on affected patients. Up to half of patients require surgery in the first 10 years after diagnosis and over 75% of operated patients require at least one further surgery within lifetime. In order to minimize surgical risk, modifiable risk factors such as nutritional status need to be optimized. This systematic review on preoperative nutritional support in adult Crohn’s patients between 1997 and 2017 aimed to provide an overview on target populations, screening modalities, routes of administration, and expected benefits. Pertinent study characteristics (prospective vs. retrospective, sample size, control group, limitations) were defined a priori. Twenty-nine studies were retained, of which 14 original studies (9 retrospective, 4 prospective, and 1 randomized controlled trial) and 15 reviews. Study heterogeneity was high regarding nutritional regimens and outcome, and meta-analysis could not be performed. Most studies were conducted without matched control group and thus provide modest level of evidence. Consistently, malnutrition was found to be a major risk factor for postoperative complications, and both enteral and parenteral routes were efficient in decreasing postoperative morbidity. Current guidelines for nutrition in general surgery apply also to Crohn’s patients. The route of administration should be chosen according to disease presentation and patients’ condition. Further studies are needed to strengthen the evidence.

show abstract

“…121 More recently, a multicenter French cohort study found no association between anti-TNF therapy and postoperative infection in ileocecal resections. 204 The multicenter PUCCINI (Prospective Cohort of Ulcerative Colitis and Crohn's Disease Patients Undergoing Surgery to Identify Risk Factors for Post-Operative INfection) trial funded by the Crohn's and Colitis Foundation is near completion in the US.…”

Section: Skin Lesionsmentioning

confidence: 99%

Update on anti-tumor necrosis factor agents and other new drugs for inflammatory bowel disease

Cohen

Sachar

2017

BMJ

115

View full text Add to dashboard Cite

The treatment of inflammatory bowel disease (IBD)-ulcerative colitis (UC) and Crohn's disease (CD)-has evolved beyond surgery with the introduction of biologic agents, primarily antibodies against mediators of inflammation and cell attraction. Anti-tumor necrosis factor (TNF) agents have been the first line treatment for moderate to severe ulcerative colitis and Crohn's disease for more than 15 years. During that time much has been learnt about how best to use these agents. This review will assess the evidence on how to optimize the use of anti-TNF agents; when and how to start treatment; how to monitor treatment and when to de-escalate it; and the potential adverse effects of these drugs. New and emerging treatments such as anti-attractants, anti-interleukins, and Janus kinase (JAK) inhibitors will also be discussed.

show abstract

Postoperative Complications after Ileocecal Resection in Crohn’s Disease: A Prospective Study From the REMIND Group

Cited by 155 publications

References 23 publications

Preoperative Enteral Nutrition and Surgical Outcomes in Adults with Crohn’s Disease: A Systematic Review

Preoperative Enteral Nutrition and Surgical Outcomes in Adults with Crohn’s Disease: A Systematic Review

Preoperative Nutritional Conditioning of Crohn’s Patients—Systematic Review of Current Evidence and Practice

Update on anti-tumor necrosis factor agents and other new drugs for inflammatory bowel disease

Contact Info

Product

Resources

About