1. Management and Long-term Outcomes of Crohn's Disease Complicated with Enterocutaneous Fistula: ECUFIT Study from GETECCU
- Author
-
Manuel Barreiro-de Acosta, Sabino Riestra, Margalida Calafat, María Pilar Soto, Marta Calvo, Eugenia Sánchez Rodríguez, Berta Caballol, Milagros Vela, Montserrat Rivero, Fernando Muñoz, Luisa de Castro, Xavier Calvet, Francisco Javier García-Alonso, Alejandra Utrilla Fornals, Rocío Ferreiro-Iglesias, Carlos González-Muñoza, María Chaparro, Luis Bujanda, Beatriz Sicilia, Erika Alfambra, Andrés Rodríguez, Rubén Pérez Fernández, Cristina Rodríguez, Pedro Almela, Federico Argüelles, David Busquets, Sonsoles Tamarit-Sebastián, Cristina Reygosa Castro, Laura Jiménez, Ignacio Marín-Jiménez, Noelia Alcaide, Estela Fernández-Salgado, Águeda Iglesias, Ángel Ponferrada, Ramón Pajares, Óscar Roncero, Víctor Jair Morales-Alvarado, Nahia Ispízua-Madariaga, Empar Sáinz, Olga Merino, Lucía Márquez-Mosquera, Mariana García-Sepulcre, Ainara Elorza, Sandra Estrecha, Gerard Surís, Manuel Van Domselaar, Alicia Brotons, Ruth de Francisco, Fiorella Cañete, Eva Iglesias, María Isabel Vera, Francisco Mesonero, Rufo Lorente, Yamile Zabana, José Luis Cabriada, Eugeni Domènech, and Iago Rodríguez-Lago
- Subjects
Adult ,Crohn’s disease ,enterocutaneous fistula ,Gastroenterology ,General Medicine ,surgery ,Crohn's disease ,Treatment Outcome ,Crohn Disease ,Intestinal Fistula ,Quality of Life ,Humans ,Rectal Fistula ,fistula ,Retrospective Studies - Abstract
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.
- Published
- 2022