Systematic review with meta‐analysis: recurrence of Crohn's disease after total colectomy with permanent ileostomy

Abstract

Background Subtotal or total colectomy or proctocolectomy with permanent ileostomy (TC-PI) may be a treatment option for medically refractory colonic Crohn's disease (CD). Aim To perform a systematic review and meta-analysis to evaluate the rate, risk factors and outcomes of CD recurrence after TC-PI. Methods In a systematic review ending March 31, 2016, we identified 18 cohort studies (1438 adults) who underwent TC-PI for colonic CD (median follow-up, 7.4 years; interquartile range, 5.3-9.0). We estimated pooled rates (with 95% confidence interval [CI]) of clinical and surgical recurrence, and risk factors for disease recurrence. Results On meta-analysis, the risk of clinical recurrence after TC-PI was 28.0% (95% CI, 21.7-35.3; 14 studies, 260/1004 patients), with a 5- and 10-year median cumulative rate of 23.5% (range, 7-35) and 40% (range, 11-60), respectively. The risk of surgical recurrence was 16.0% (95% CI, 11.1-22.7; 10 studies; 183/1092 patients), with a 5- and 10-year median cumulative rate of 10% (range, 3-29) and 18.5% (range, 14-34), respectively. The risk of clinical and surgical recurrence in patients without ileal disease at baseline was 11.5% (95% CI, 7.7-16.8) and 10.4% (95% CI, 4.5-22.5), respectively. History of ileal disease was associated with 3.2 times higher risk of disease recurrence (RR, 3.2; 95% CI, 1.8-5.6). Other inconsistent risk factors for disease recurrence were penetrating disease and young age at disease onset. Conclusions Small bowel clinical recurrence occurs in about 28% of patients after TC-PI for colonic CD. Disease recurrence risk is 3.2 times higher in patients with history of ileal disease, and continued medical therapy may be advisable in this population. In patients without ileal inflammation at surgery, continued endoscopic surveillance may identify asymptomatic disease recurrence to guide therapy.

ECCO-ESGAR Guideline for Diagnostic Assessment in IBD Part 1: Initial diagnosis, monitoring of known IBD, detection of complications

“…In a recent meta-analysis of 18 cohort studies, the risk of clinical recurrence was 28.0%, with a 5-year and 10-year median cumulative rate of 23.5%. 305 Identification and treatment of early mucosal recurrence may therefore prevent clinical recurrence.…”

Diagnostic efficacy of double-balloon enteroscopy in patients with suspected isolated small bowel Crohn’s disease

“…Surgical removal of the stenosis is a recognized solution, and half of patients require surgery within the first decade of diagnosis. A meta-analysis [33] has reported that small bowel clinical recurrence occurs in approximately 28% of patients after total colectomy with permanent ileostomy for colonic CD. Endoscopic balloon dilation (EBD) is a safe and effective method that can replace small bowel resection in some cases [34].…”

Diagnostic efficacy of double-balloon enteroscopy in patients with suspected isolated small bowel Crohn’s disease

“…Surgical removal of the stenosis is a recognized solution, and half of patients require surgery within the first decade of diagnosis. A meta-analysis [33] has reported that small bowel clinical recurrence occurs in approximately 28% of patients after total colectomy with permanent ileostomy for colonic CD. Endoscopic balloon dilation (EBD) is a safe and effective method that can replace small bowel resection in some cases [34].…”