Management and Long-term Outcomes of Crohn's Disease Complicated with Enterocutaneous Fistula: ECUFIT Study from GETECCU
Por:
Barreiro-de Acosta, M, Riestra, S, Calafat, M, Soto, M, Calvo, M, Rodriguez, E, Caballol, B, Vela, M, Rivero, M, Munoz, F, de Castro, L, Calvet, X, Garcia-Alonso, F, Fornals, A, Ferreiro-Iglesias, R, Gonzalez-Munoza, C, Chaparro, M, Bujanda, L, Sicilia, B, Alfambra, E, Rodriguez, A, Fernandez, R, Rodriguez, C, Almela, P, Arguelles, F, Busquets, D, Tamarit-Sebastian, S, Castro, C, Jimenez, L, Marin-Jimenez, I, Alcaide, N, Fernandez-Salgado, E, Iglesias, A, Ponferrada, A, Pajares, R, Roncero, O, Morales-Alvarado, V, Ispizua-Madariaga, N, Sainz, E, Merino, O, Marquez-Mosquera, L, Garcia-Sepulcre, M, Elorza, A, Estrecha, S, Suris, G, Van Domselaar, M, Brotons, A, de Francisco, R, Canete, F, Iglesias, E, Vera, M, Mesonero, F, Lorente, R, Zabana, Y, Cabriada, J, Domenech, E and Rodriguez-Lago, I
Publicada:
4 ago 2022
Ahead of Print:
1 feb 2022
Resumen:
Background and aims Crohn's disease [CD] can develop penetrating complications at any time during the disease course. Enterocutaneous fistulae [ECF] are disease-related complications with an important impact on quality of life. Our aim was to describe the outcomes of this complication, including its medical and/or surgical management and their temporal trends. The primary endpoint was fistula closure, defined as the absence of drainage, with no new abscess or surgery, over the preceding 6 months. Methods Clinical information from all adult patients with CD and at least one ECF-excluding perianal fistulae-were identified from the prospectively-maintained ENEIDA registry. All additional information regarding treatment for this complication was retrospectively reviewed. Results A total of 301 ECF in 286 patients [January 1970-September 2020] were analysed out of 30 088 records. These lesions were mostly located in the ileum [67%] and they had a median of one external opening [range 1-10]. After a median follow-up of 146 months (interquartile range [IQR], 69-233), 69% of patients underwent surgery. Fistula closure was achieved in 84%, mostly after surgery, and fistula recurrence was uncommon [13%]. Spontaneous and low-output fistulae were associated with higher closure rates (hazard ratio [HR] 1.51, 95% confidence interval [CI] 1.17-1.93, p = 0.001, and HR 1.49, 95% CI 1.07-2.06, p = 0.03, respectively); this was obtained more frequently with medical therapy since biologics have been available. Conclusions ECF complicating CD are rare but entail a high burden of medical and surgical resources. Closure rates are high, usually after surgery, and fistula recurrence is uncommon. A significant proportion of patients receiving medical therapy can achieve fistula closure.
Filiaciones:
Barreiro-de Acosta, M:
Hosp Clin Univ Santiago, Gastroenterol Dept, Santiago De Compostela, Spain
Riestra, S:
Hosp Univ Cent Asturias, Inst Invest Sanitaria Principado Asturias, Gastroenterol Dept, Oviedo, Spain
Calafat, M:
Hosp Badalona Germans Trias & Pujol, Gastroenterol Dept, Madrid, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Soto, M:
Hosp Univ Reina Sofia, Gastroenterol Dept, Cordoba, Spain
Calvo, M:
Hosp Univ Puerta de Hierro, Gastroenterol Dept, Majadahonda, Spain
Rodriguez, E:
Hosp Univ Ramon y Cajal, Gastroenterol Dept, Madrid, Spain
Caballol, B:
Hosp Clin Barcelona, Gastroenterol Dept, Barcelona, Spain
Vela, M:
Hosp Univ Nuestra Senora de Candelaria, Gastroenterol Dept, Santa Cruz De Tenerife, Spain
Rivero, M:
Hosp Univ Marques de Valdecilla, Gastroenterol Dept, Santander, Spain
IDIVAL, Santander, Spain
Munoz, F:
Hosp Univ Salamanca, Gastroenterol Dept, Salamanca, Spain
de Castro, L:
Hosp Alvaro Cunqueiro, Gastroenterol Dept, Vigo, Spain
Calvet, X:
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Corp Parc Tauli, Gastroenterol Dept, Madrid, Spain
Sabadell, Madrid, Spain
Garcia-Alonso, F:
Hosp Univ Rio Hortega, Gastroenterol Dept, Valladolid, Spain
Fornals, A:
Hosp Gen San Jorge, Gastroenterol Dept, Huesca, Spain
Ferreiro-Iglesias, R:
Hosp Clin Univ Santiago, Gastroenterol Dept, Santiago De Compostela, Spain
Gonzalez-Munoza, C:
Hosp Santa Creu & Sant Pau, Gastroenterol Dept, Barcelona, Spain
Chaparro, M:
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Hosp Univ La Princesa, Gastroenterol Dept, Inst Invest Sanitaria Princesa IIS IP, Madrid, Spain
Bujanda, L:
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Biodonostia Hlth Res Inst, Gastroenterol Dept, San Sebastian, Spain
Univ Pais Vasco UPV EHU, San Sebastian, Spain
Sicilia, B:
Hosp Univ Burgos, Gastroenterol Dept, Burgos, Spain
Alfambra, E:
Hosp Clin Univ Lozano Blesa, Gastroenterol Dept, Zaragoza, Spain
Rodriguez, A:
Hosp Gen Univ Alicante, Gastroenterol Dept, Alicante, Spain
Fernandez, R:
Complejo Asistencial Univ Leon, Gastroenterol Dept, Leon, Spain
Rodriguez, C:
Complejo Hosp Navarra, Gastroenterol Dept, Pamplona, Spain
:
Hosp Gen Univ Castello, Gastroenterol Dept, Castellon de La Plana, Spain
Arguelles, F:
Hosp Univ Virgen Macarena, Gastroenterol Dept, Seville, Spain
Busquets, D:
Hosp Univ Girona Dr Josep Trueta, Gastroenterol Dept, Girona, Spain
Tamarit-Sebastian, S:
Hosp Gen Tomelloso, Gastroenterol Dept, Tomelloso, Spain
Castro, C:
Complejo Hosp Univ Canarias, Gastroenterol Dept, San Cristobal De Laguna, Spain
Jimenez, L:
Hosp Univ Fuenlabrada, Gastroenterol Dept, Fuenlabrada, Spain
Marin-Jimenez, I:
Hosp Gen Univ Gregorio Maranon, Gastroenterol Dept, Madrid, Spain
Alcaide, N:
Hosp Clin Univ Valladolid, Gastroenterol Dept, Valladolid, Spain
Fernandez-Salgado, E:
Complejo Hosp Univ Pontevedra, Gastroenterol Dept, Pontevedra, Spain
Iglesias, A:
Complexo Hosp Univ Ourense, Gastroenterol Dept, Orense, Spain
Ponferrada, A:
Hosp Univ Infanta Leonor, Gastroenterol Dept, Madrid, Spain
Pajares, R:
Hosp Univ Infanta Sofia, Gastroenterol Dept, San Sebastian De Reyes, Spain
Roncero, O:
Hosp Gen La Mancha Ctr, Gastroenterol Dept, Alcazar De San Juan, Spain
Morales-Alvarado, V:
Hosp Gen Granollers, Gastroenterol Dept, Granollers, Spain
Ispizua-Madariaga, N:
Hosp Univ Basurto, Gastroenterol Dept, Bilbao, Spain
Sainz, E:
Xarxa Assistencial Univ Manresa, Gastroenterol Dept, Manresa, Spain
Merino, O:
Hosp Univ Cruces, Gastroenterol Dept, Baracaldo, Spain
Marquez-Mosquera, L:
Hosp Parc de Mar, Gastroenterol Dept, Barcelona, Spain
:
Hosp Gen Univ Elche, Gastroenterol Dept, Elche, Spain
Elorza, A:
Hosp Univ Galdakao, Biocruces Bizkaia Hlth Res Inst, Gastroenterol Dept, Galdakao, Spain
Estrecha, S:
Hosp Univ Araba, Gastroenterol Dept, Vitoria, Spain
Suris, G:
Hosp Univ Bellvitge, Gastroenterol Dept, Lhospitalet De Llobregat, Spain
Van Domselaar, M:
Hosp Univ Torrejon, Gastroenterol Dept, Torrejon De Ardoz, Spain
:
Hosp Vega Baja, Gastroenterol Dept, Orihuela, Spain
de Francisco, R:
Hosp Univ Cent Asturias, Inst Invest Sanitaria Principado Asturias, Gastroenterol Dept, Oviedo, Spain
Canete, F:
Hosp Badalona Germans Trias & Pujol, Gastroenterol Dept, Madrid, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Iglesias, E:
Hosp Univ Reina Sofia, Gastroenterol Dept, Cordoba, Spain
Vera, M:
Hosp Univ Puerta de Hierro, Gastroenterol Dept, Majadahonda, Spain
Mesonero, F:
Hosp Univ Ramon y Cajal, Gastroenterol Dept, Madrid, Spain
Lorente, R:
Hosp Gen Univ Ciudad Real, Gastroenterol Dept, Ciudad Real, Spain
Zabana, Y:
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Hosp Univ Mutua Terrassa, Gastroenterol Dept, Madrid, Spain
Cabriada, J:
Hosp Univ Galdakao, Biocruces Bizkaia Hlth Res Inst, Gastroenterol Dept, Galdakao, Spain
Domenech, E:
Hosp Badalona Germans Trias & Pujol, Gastroenterol Dept, Madrid, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Rodriguez-Lago, I:
Hosp Univ Galdakao, Biocruces Bizkaia Hlth Res Inst, Gastroenterol Dept, Galdakao, Spain
Open Access
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